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Vol. II.
\^W\(W\ktV\frV'
No. I.
The Journal of
Mental
hology
Subscription Price : — $2.
ingle Copies, 50 cents*
Edited by Louise G. Robinovitch, B. ts L., M.D.
editorial Board
Dr. V. MAGNAN, Dr. A. JOFFROY, Dr. F. RAYMOND (Paris), Dr. CHAS. K. MILLS (Phila.),
Dr. JUL. MOREL (Belgium), Dr. E. REGIS (Bordeaux), Dr. G. CESARE FERRARI, Editor Revista
Sperim. di Fren. (Italy).
Contributors9 Staff
ALBANEL, L., LL. D., President Society Family Patronage (Paris) ; BAILEY, Dr. P. (New York) ;
BAJENOW, Dr., (Moscow); BECHTEREW, Prof. (Russia); BERILLON, Dr. Edgar (Paris);
BLEULER, Prof. E. (Zurich); BLIN, Dr.; BOISSIER, Dr. F.; BOURNEV1LLE, Dr., Chief Physi-
cian Bicetre Asylum, Editor Progres Medical; BRAESCO, Dr. Al. N. (Roumania); BRIAND, Physician
to the Asylums of the Seine; BALLET, Prof. G., Faculty of Medicine (Paris); CHATTERJI, Mr. J. C.
(Benares, India); CLAPAREDE, Dr. Ed., Editor Archives ds Psyckologie (Switzerland); CROCQ,
Prof., Editor Journal de Neurologie (Belgium) ; DRILL, Dimitri, LL. D., Jurist Ministry of Justice
(Russia); DEKTEREW, Dr. W. de, Member Municipal and General Council (Russia); DAGONET, Dr.;
FAURE, Dr. Maurice; FERRI, E., LL. D., Deputy (Rome, Italy); FAREZ, Dr. Paul; GREIDENBERG,
Dr. B. S. (Russia) ; GARNIER, Dr. P., Expert at the Tribunals (Paris) ; JANET, Dr. (Paris) ; KOPOS-
SOW, Dr., Superintendent Simbirsk Asylum; LALANNE, Dr.; LANGELAAN, Dr. J. W. (Holland);
LEGRAS, Dr.; LEGRAIN, Dr.; LOURIE, Ossip, Ph. D. (Paris); MARRO, Prof., Dir. "Annali di
Freniatria" (Italy); MARIE, Dr. Auguste, Chief Physician Villejuif Asylum; MARINESCO, Prof. G.
(Roumania); MARTIN, Dr. E. (France); MEDICI, Dr.; MacDONALD, Dr. A. E., Superintendent
Manhattan State Hospital (New York); NAMMACK, Dr. Ch.; NE1SSER, Dr. CLEMENS, Chief
Physician of the County Asylum, Leubus (Germany); OBICI, Dr. (Italy); PETERSON, Dr. F., Com-
missioner in Lunacy, State of New York; PIERON, Dr. H., Preparateur Laboratory Experim. Psych.,
School of Higher Studies (Villejuif); PHILIPPE, Dr. CI.; REIS, Dr. Mello (Brazil); ROBERTSON,
Dr. F. W., General Superintendent Elmira Reformatory; REY, Dr. Philippe, Superintendent Public
Asylums (Aix) ; RITTI, Dr. Ant., Chief Physician Charenton Asylum; SEMELAIGNE, Dr. Ren6;
SEMIDALOW, Dr. B. (Russia); SERIEUX, Dr. P. (France); SERGI, Prof. G. (Italy); SINANI, Dr.
B. N. (Russia); SERBSKI, Dr. V. P. (Moscow); SNELL, Dr.; SPITZKA, E. A. (New York);
STOENESCU, Dr. N. (Roumania); TATY, Dr. (France); TSCHISCH, W., Prof. (Russia); TREVES,
Dr. Marco (Italy) ; TOULOUSE, Dr. E., Chief Physician Villejuif Asylum, Director Laboratory Exper.
Psych., School of Higher Studies; TRUELLE, Dr.; VAN HAMEL, G. A., Prof. Criminal Law, Univ.
Amsterdam; VURPAS, Dr. CI., Asylums of the Seine; VAN GIESON, Dr. Ira T.; VALLON, Dr.,
Physician to Ste. Anne, Expert at the Supreme Courts (Paris) ; VASCHIDE, Dr. N., Chef des Travaux,
Laboratory Exp. Psychol. (Paris) ; VOISIN, Dr. Jules, Physician to the Salpetriere (Paris) ; WINKLER,
Dr. C, Univ. Amsterdam.
STATE PUBLISHING COMPANY
290 Broadway, NEW YORK, N. Y.
TABLE OF CONTENTS
LEADING ARTICLES.
The Relation of the Human Cranial Forms During Foetal Develop-
ment and Adult Age, Prof. G. Sergi i
On the So-called Occipital Type of Cranial Construction in the Men-
tally Degenerate, Dr. Vorobiov 10
A Contribution to the Study of Acute Delirium. A Physical Disease
of Scorbutic Origin, Haemorrhagic Encephalitis of Strumpel, Dr. B.
Semidalow 13
Experiments on the Motor Precision of the Sane and the Insane,
Dr. Carlo Scappucci 18
The Genesis of Epilepsy Clinically Considered. The Pathology, Pro-
phylaxis and Treatment of Epilepsy, Dr. Robinovitch 24
Note on a Phenomenon of Immediate Foresight, Kama Fairbanks ... 35
EDITORIALS.
Science vs. Secrecy 39
Communication 41
TRANSLATIONS AND ABSTRACTS OF CURRENT LITERATURE.
Study of the Aphasia Persisting During Convalescence After Evacua-
tion of Brain Abscess 42
Contribution to the Study of the Mental Structure of Hallucinations . 47
A Case of Mental and Nervous Disturbances Due to Hepatic Intoxica-
tion 48
On the Question of the Epileptic State 48
Cerebral Abscess Following Chronic Otorrhea 49
Anomalies du Polygone Arteriel de Willis chez les Criminels 49
The Working of the Inebriates Act 5°
Phthisis and Insanity 5°
On the Favorable Results of Transference of Insane Patients from One
Asylum to Another 50
The Cerebral Localization of Melancholia 51
Physical and Moral Insensibility in the Criminal 52
Disturbance of Speech in Malaria 52
Heredity and Poetic Talent 53
Psychic Treatment 53
The Treatment of Deafness by Sonorous Vibrations 53
Abnormal Brain Development 54
Is Legal Recognition of Graduate Responsibility Practicable ? 54
BOOK REVIEWS.
Vorlesungen Uber Psychopathologie in Ihrer Bedeutung fur die Nor-
male Psychologie mit Einschluss der Psychologischen Grundlagen der
Erkentnistheorie, Gustave Storring 55
Le Crime Dans la Famille, Louis Albanel 54
Die Behandlung Idiotischer und Imbeciller Kinder in Arztlicher und
Pedagogischer Beziehung, WUhelm Weygand 56
Books and Pamphlets received 3d cover
The Journal of Mental Pathology.
Vol. II. FEBRUARY, 1902. No. 1.
THE RELATION OF THE HUMAN CRANIAL
FORMS DURING FG5TAL DEVELOPMENT
AND ADULT AGE.
BY PROF. G. SERGI.
University of Rome.
For the definition and classification of the cranial forms accord-
ing to my morphological method, I have chosen the species which
I denominate Eurafrican. This is a pentagonal form known as
pentagono'id (Fig. i). Other principal and dominating forms of
the same species are the ellipsoid (Fig. 2), and the ovoid (Fig. 3).
From a study of fetal and adult craniums I have found that the
pentagonal is far more frequent in the foetal than in the adult
forms. This fact made me suspect that the pentagonal form in
the human cranium is only transitory, disappearing as the cranium
assumes the proper characteristics of adult age. In order to verify
this suspicion, I made a series of studies of collections of human
craniums, almost all of which were at full term. One collection
was studied with my friend, Prof. Berte, at the University of
Catania, and three other collections in Paris. Two of these latter
are at the Museum of Comparative Anatomy, at the Jardin des
Plantes, and the third in Broca's Anthropological Museum. The
Italian collection counts forty-one craniums and the French sev-
enty-eight, making in all 119. The age of the French craniums
ranges between the second and the tenth fcetal months, or some-
what beyond the date of birth.
The following is a summary of the study of the forms :
Of the Italian collection, consisting of 41 craniums, almost all
at full term, between 8 and 9 months, 33 are pentagonoidal, or
80.49 Per cent., and 8 are of various forms, as follows : 3 ellipsoid
and 2 ovoid — in all 19.51 per cent.
2 CRANIAL FORMS.— Prof. Sergi.
The French collection of 78 craniums is composed of the fol-
lowing forms :
Pentagonoidal, between the seventh month to full term — 41, or
52.56 per cent.
Ovoidal, between the seventh month and full term — 6, or 7.69
per cent.
Ellipsoid, idem — 8, or 10.25 per cent.
Other forms; idem — 3, or 3.87 per cent.
Ellipso-ovoidal, below the seventh month — 18, or 23.05 per cent.
Various forms, idem — 2, or 2.56 per cent.
Total, 78; 100 per cent.
If we were to exclude the craniums below the age of seven
months, for a reason which will be explained presently, we would
have the following proportions :
Pentagonoidal, seventh month to full term — 41, or 70.69 per cent.
Various forms, seventh month to full term — 17, or 17.29.31 per
cent.
Total, 58 ; 100 per cent.
If, finally, all the series are united, with the exception of crani-
ums under the seven months, the total of 99 craniums can be
divided into:
Pentagonoidal — 74, or 74.74 per cent.
Various forms — 25, or 25.25 per cent.
Total, 99 ; 100 per cent.
In other words, the craniums between the ages of seven months
and full term are of pentagonoidal form in the proportion of from
70 per cent, to 80 per cent. The adult craniums, on the contrary,
as will be seen from the table of 1692 craniums, show 16.84 per
cent, only of pentagonoidal forms, and 83.15 per cent, of ellipso-
ovoidal; thus the proportion is inverted and shows that the pen-
tagonoidal form in the Eurafrican species is only transitory and is
characteristic of the fcetal state.
The cranial forms found in the various series may be thus classi-
fied:
1. — Acute oblong pentagonoidal.
2. — Obtuse oblong pentagonoidal.
3. — Broad pentagonoidal.
4. — Ellipsoid.
5. — Ovoid.
6. — Broad, undefinable forms.
To these forms others could be added, but they have no special
morphological significance.
The first category comprises the typical form, and is repre-
sented in Fig. 4 ; it shows an acute pentagonoidal form with prom-
CRANIAL FORMS.— Prof. Sergi. 3
inent parietal protuberances, from which a gradual attenuation
is seen in the frontal direction, thus forming a marked pentagon.
A variety of such a pentagon is seen in Fig. 5. It shows an attenu-
ated and oblong cranium, retaining the pentagonal form. The first
I denominate acute foetal pentagonoid, and the second, attenuated
foetal pentagonoid.
There are, besides, pentagonoid forms in which the parietal
angles are round ; this form I call obtuse foetal pentagonoid.
The third category of the pentagonoid is characterized by an
abridgement of the anterior cranial part, which brings about a
relatively diminished maximum width and antero-posterior length.
I call this form broad pentagono'idal (Fig. 6). A variety of this
form is seen in Fig. 7. This figure represents cranium 136 of the
Gall collection, No. 5560 of the collection in the Paris Museum of
Comparative Anatomy.
The foetal ellipsoid (Fig. 8), and foetal ovoid (Fig. 9), are, by
their forms, descriptive of themselves, the parietal angles being
almost invisible.
The sixth category has no pentagono'idal form, properly speak-
ing. It has two types, which I call broad form, types "A" and
"B." Both these broad forms seem to approach in shape the ellip-
soid and ovoid. The type "A" (Fig. 10), differs from "B" (Fig.
11), in that "B" is in the process of assuming a definite cuneiform
shape. This is seen in the sharpness of one extremity, and the
maximum expansion of the parietals is nearer the posterior cranial
quarter; thus, there is a maximum and gradual attenuation from
behind forward, such as is seen in the form of a large wedge. Type
"A," on the contrary, has its maximum width near the posterior
third, or rather more forward, and is characterized by a definite
curve tending towards an ellipse.
I call these varieties indefinite broad forms type "A" and "B," a
collection of which exists in the Paris Museum of Comparative
Anatomy. Those which I designate by the letter "C" are to be
found in the Museum Broca, and those I designate by "I" are of the
Italian collection.
From the individual study of 119 craniums contained in my
table, it is seen that :
1 — The pentagonal form does not appear before the seventh
month of uterine life.
2 — The ellipso-ovoid and other forms also show their angles
from the seventh month to full term, without, however, giving the
cranium a pentagono'idal form.
3 — Before the seventh month and the first appearance of ossifi-
cation in the various cranial flat bones, I found a gradual forma-
4 CRANIAL FORMS.— Prof. Sergi.
tion of convexity, and then the appearance of protuberance, which
became marked at the seventh month.
From the second month of uterine life one may observe the
presence of a convexity in the cranial bones ; this convexity aug-
ments with age, in the parietal frontal and occipital bones, when
these become individualized. At that stage the acute pentagonoidal
form appears, more or less marked or effaced, according to the
type of the bone.
These facts show that the pentagonoidal cranial form is a for-
mation of the latter part of fcetal life, beginning with the seventh
month.
With few exceptions, these pentagonal forms are not perma-
nent, as was remarked before, when the individual reaches the
adult stage. This fact is easily seen from a comparative table of
the cases which I have designated by the letters "A," "B," "C" and
"I," giving the numerical proportions of the cranial forms during
uterine and adult age. This table shows the large proportion of
the pentagonal form, beginning with the seventh uterine month.
In these four series are found :
Pentagonoid — 74, from the seventh month on.
Ovoid — 14, from the fourth month on.
Ellipsoid — 23, from the second month on.
Various forms — 8.
Total — 1 19.
In the statistical table below, I give the three principal cranial
forms found among the various nations. Some of these forms are
of the Eurafrican species, and the table shows how much the
pentagonoidal form is reduced in the adult.
STATISTICAL TABLE OF ADULT CRANIUMS ACCORDING TO FORM.
Ellipsoid.
Russian Kurgans ( 1 ) 360
Russian cemetery XVL, Moscow (1) . . 13
Ancient Rome (2) 27
Ancient Egypt (3) 29
Abyssinia (3) 37
Wales (3) —
Canary Islands (3) 4
Alfedena (4) 21
Ancient Sicily (5) 7
Aquileja (6) 15
Modern Rome (7) 44
Me.liaeval Rome (8) 9
Pentag-
Ovoid.
onoid.
103
136
5
13
27
15
10
10
19
21
—
5
1
3
6
11
10
4
8
4
3
4
—
15
CRANIAL FORMS.— Prof. Sergi. 5
Umbria (9) 32 29 2
Emiliana ( 10) 354 109 49
Venetia (11) 12 13 3
Total 964 343 295
Grand total, 1,602 60.2% 21.4% 18.4%
Of the 1,602 craniums, there are only 295 absolutely penta-
gonoidal, or 18.4 per cent. ; almost a sixth part among the ellipsoid
and ovoid.
As I have said above, of the 90 craniums, between the seventh
and tenth month, the pentagonoidal amount to 74.74 per cent., and
the other forms to 25.26 per cent. Of the 1,602 adult craniums, the
pentagonoidal amount to 18.4 per cent., and the ellipso-ovoid to
81.6 per cent.
Now let us study the cause that determines the foetal pen-
tagonoidal form. I believe that this cause must lie in the process of
ossification.
It is generally admitted that every cranial osseous segment of
membraneous origin has its ossification point in the centre ; so that
in each of the two parietal and frontal bones which unite into one
bone the first year after birth, and in the occipital, which appears
as one bone at birth, there is such a centre. Thus, the mem-
branous cranium has five ossification points, as is shown in Fig.
12, which has five eminences corresponding to five central points in
every osseous segment of the cranium. Every central ossification
point forms a focus, it is claimed, from which the ossification pro-
cess extends marginally; hence, that point, or those points, must
assume a mammillary eminence, so well marked in the parietal
bones ; for this reason the cranium assumes the pentagonoidal form
in relation to the normal vertical line.
The ossification process is carried on in a different mode in the
membranous cranium, however, in contradiction to what has been
stated above. In the beginning, calcareous elements are scattered
in the connective tissue; many scattered ossification points are
formed over the membrane, without any order and without any in-
dication of an ossification centre. These isolated points then come
gradually in contact; they become united by a network, and the
lacunae of the latter become filled, in their turn, by new deposits
of mineral salts, constituting, finally, a compact unit. Then, both
the principal and accessory network, which have formed withoift
any fixed rule, unite, and converge towards a central point in the
bone in formation, which point slowly gains in consistency, uniting
with all parts of the reticulum.
6 CRANIAL FORMS.— Prof. Sergi.
Then, some part of the coalescent mass assumes a major consist-
ency as well as resistance ; while the marginal parts tend to expand
and dilate, the central point folds up into a cone of resistance and
eventually assumes the mammillary form of the various osseous
segments : the parietal, frontal and occipital. This takes place after
the coalesence of their constituent parts, which develop separately
during the process of ossification.
This explains the flatness of these bones during their formation.
There can be no protuberance before there is coalescence of the net-
work of the osseous reticulum, — before the latter has its central
condensation and its expansion from the central point to the periph-
ery. From my studies I conclude that the protuberances form after
the fifth month of uterine life and reach their maximum after the
seventh month. At that period the protuberances of the cranial
osseous segments appear well defined and developed according to
their respective types, as classified in the table.
Thus, it seems to me that the appearance of the pentagonal
form after the seventh uterine month depends on the ossification
which takes place through a significant mechanism. The five cen-
tres which correspond to the five eminences; as seen in Fig. 12, are
formations depending on the ossification process, and not on the
parting points or ossification centres. If, indeed, there existed
primary ossification centres, the mammillary eminences would ap-
pear at the beginning of the ossification process ; but we have seen
that they appeared after the fifth month and were formed after
the seventh only.
We must now find the process by which the pentagonoidal foetal
form disappears during the growth after birth. We have seen,
indeed, that in the adult craniums the pentagonoidal forms are
reduced to a little over 18 per cent., a new form, more definite,
becoming the characteristic of the adult cranium.
Those adult forms are ellipsoid and ovoid, on one hand, and
spheroidal, cuneiform and platicephalic on the other.
This change of form depends on the growth of the brains and
the corresponding cranial growth. After birth, especially during
the first year, the brain increases in size considerably ; the cranium
must expand accordingly ; as it increases in size its angles be-
come rounded, assuming definite curves and greater uniformity,
while the bones' structure condenses and thickens ; hence, the cone
of resistance becomes useless.
I thus explain the disappearance of the foetal ' pentagonoidal
cranium, when it becomes an adult one, or while growing to be-
come an adult one.
As for the 18 per cent, of the pentagonoidal adult craniums above
CRANIAL FORMS.— Prof. Sergi. 7
mentioned, whether persisting in this form or its modifications,
such craniums present the characteristics which I call infantile, be-
cause craniums with these traits have not assumed the adult form,
but, on the contrary, have retained one of the fcetal traits, either
in part or in whole.
Similar traits, when found in the pelvis, not only point to arrest
in development, but also indicate that there is an absence of the
sexual form.
In conclusion I would say that :
The pentagonoidal form of the fcetal cranium predominates to
a degree of from 70 to 80 per cent.
The ellipso-ovoidal forms are rare, as are those with acute
parietal angles.
The adult forms, ellipsoid, ovoid, and others, are transforma-
tions of the fcetal pentagonoidal, which latter is a transitory form.
Among adult forms there are, however, pentagonoidal. These
are incompletely transformed.
The adult pentagonoidal are infantile craniums.
The cause of the pentagonoidal form should be found in the
ossification process of the cranial membranes ; the formation of
the protuberances or mammillary eminences which impart the
shape of a pentagon begins at the fifth uterine mouth, and ends at
the seventh.
The disappearance of the protuberances in the osseous segments
and the appearance of the definite adult cranial form depends on
the mechanical action of the cerebral growth within the cranium.
REFERENCES.
* SPECIE E VARIETAI UMANE. SAGGIO di una sistematica antro
pologica. Torino, 1900.
(1) SERGI. Catalogo delle varieta umane dell Russia e del Mediterra-
neo. Att. rom. Antrop. 1893 I.
(2) SERGI. Studi di Antropologia laziale. Boll. Accad. Medica di
Roma, 1895.
(3) SERGI. Africa, 1897.
(4) SERGI. Arii e Italici, 1898. Crani antichi di Alfedena. Soc. rom.
di Antrop., 1899.
(5) SERGI. Crani preistorici della Sicilia. Atti Soc. Rom. Antrop.,
1899., Vol. VI.
(6 VRAM. Crani antichi e medioevali di Aquileja. Atti Soc. Rom. di
Antrop., 1899, Vol. VI.
(7) MINGAZZINI. Craniologia degli alienati. Atti Soc. Rom. Antrop.,
I, 1893.
(8) MOSCHEN. Crani Romani dell'epoca cristiana. Atti Soc. Rom.
Antrop., I., 1893-4.
8
CRANIAL FORMS.— Prof. Sergi.
(9) MOSCHEN. Una centuria di crani umbri moderni. Atti Soc. Rom.
Antrop., IV., 1896.
(10) GIUFFRIDA-RUGGERI. La statura in rapporto alle forme era-
niche. Atti Soc. Rom. Antrop., Vol. V., 1898.
(n) TEDESCHI. Studi di antropologia veneta. Atti Soc. Rom.
Antrop., Vol. V., 1897.
Individual studies of 119 cases during fcetal age, tabulated studies of
the varieties designated by the letters "A," "B," "C" and "I," and a
detailed catalogue of cranial forms and measurements appended to this
paper are omitted in this publication. — Ed.
90 tj
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Fig. 4.
Acute Foetal Pentagonoidal.
Fig. 5.
Foetal Pentagonoidal.
Fig. 6.
Broad Foetal Pentagonoidal.
Fig. 7-
Very Broad Pentagonoidal.
Fig. 8.
Foetal Ellipsoid.
Fig. 9.
Foetal Ovoid.
Fig. 10.
Broad Form A.
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Fig. 11.
Broad Form B.
Fig. 12.
Diagram of the Cranial Eminences.
10 CRANIAL CONSTRUCTION.— Dr. Vorobiov.
ON THE SO-CALLED OCCIPITAL TYPE OF CRANIAL
CONSTRUCTION IN THE MENTALLY DEGENERATE.*
It has been the aim of scientists to establish a method
by which one could determine to what human type a given
skull belongs ; the higher, the lower or the degenerate. After
a careful analysis of the results that can be obtained by
various cranial measurements Dr. Vorobiov concludes that the
least erroneous measurements are those of the anterior part
of the brain; the part measured by a line starting from
the foremost frontal point and ending at the central junction
of the bi-auricular lines. For the sake of shortness, this line is
called ophrion-tragus, as the junction of the bi-auricular lines takes
place just in front of the tragus. Many objections can be made to
this method, but it seems to be the least erroneous of all. A few
figures thus obtained are not strikingly characteristic, as was an-
ticipated ; in the healthy, the average height of the forehead is 70.3
mm., the individual extremes being from 52 to 88 mm. ; in the
insane, the same height was 69.4 mm., the only difference in favor
of the normal being 0.9 mm., too insignificant a figure to be of any
importance ; but the individual range in the latter was between
48 and 95 mm., showing that among the insane one finds more
cases of extreme measurements of frontal height.
In further investigations, care was taken to procure uniformity
of individuals. For this purpose typical psychic patients with
marked hereditary taint were chosen. To assure uniformity of
race, the Velikorouss only were chosen — preferably from the old
Vladimiro-Souzdalski section, which is now known as the Riazian-
ski and Moscow Provinces ; in order to obviate social differences,
subjects of the peasant class only were examined — subjects who
had spent their childhood and adolescence in pleasant surround-
ings. The group of normal subjects which were to serve as a
comparative unit was thus selected : For every insane patient desig-
nated there was also found a subject approximately of the same age
and stature (the age did not exceed five years' difference and the
height remained within the limit of 1 centimetre's difference). Be-
sides, wishing to remain within the limits of accuracy, the above
persons were chosen so that their longitudinal diameter of the
head presented no greater difference from one another than 1 mm.
This latter point was carried out with the view of finding what dif-
ference there existed between the frontal and the occipital meas-
urements in the respective groups, every subject of which presented
the same longitudinal measurement.
Fearing that he would be too much influenced by the desire to
* Journal S. S. Korsakova, Nov. 2, 1901.
CRANIAL CONSTRUCTION.— Dr. Vorobiov. II
select identical subjects for comparison, the author chose yet a
third group, similar to the insane; in this third group only those
subjects entered whose transverse cephalic diameter was identical
with that of the insane. An extra precaution was taken to re-
main ignorant of all other traits, except those the identity of which
was desired. The 50 insane subjects represented the following
groups of diseases:
Periodic insanity 18 patients.
Circular insanity 4 patients.
Neuro-degenerative forms (chron. delus. ins. of syst.
evol., etc.) 8 patients.
Epileptic psychoses (with marked heredity and early
onset of the disease) 9 patients.
Psychoses with marked obsessions and impulses (with
pronounced heredity) 1 1 patients.
Total 50
The table below shows the result of the three selected groups,
as well as of 325 subjects from Riaziansk:
O C O i-i
.« .bo-2 .« uw g
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Height 1664.4 mm. 1655. 1 mm. 1660.8 mm. 1651.3 mm.
Maximum longitudinal
cranial diameter 187.64 mm. 187.76 mm. 186.80 mm. 188.08 mm.
Maximum transverse
cranial diameter 154.90 mm. 154.08 mm. 154.90 mm. 153.1 mm.
Cranial index 82.53 mm. 81.87 mm. 82.86 mm 81.48 mm.
Horizontal cranial cir-
cumference 561.3 mm. 560.1 mm. 563.2 mm. 561.5 mm.
From the comparison of the figures in the second, third and
fourth columns of the table, it is seen that there is no essential
cranial difference between the insane and the masses of Riaziansk
subjects, from among whom the comparative normal groups were
chosen. The most marked difference is seen in the matter of
height ; this is simply because the insane happened to be of taller
stature.
One might object to the intrinsic comparative value of columns
1, 2 and 3; but when column 1 is compared with column 4, one is
forced to conclude that the identity between these two is not an
artificial one; the 325 subjects examined in column 4 having been
taken at random.
12 CRANIAL CONSTRUCTION.— Dr. Vorobiov.
With the knowledge thus obtained showing that the cranial
measurements are identical in both the insane and normal subjects,
it was desirable to find out whether any difference existed in the
frontal and occipital portions in the respective groups. The occipi-
tal measurements were not investigated for reasons of possible
inaccuracy of method ; the frontal alone were considered, as indi-
cated by the ophrion-tragus line. As the human cranium presents
asymmetry with the differences of measurement of the right and
left sides and in the insane and normal, as shown below, an average
was taken of the sum of the right and left measurements.
Among the 50 insane the difference of right and left measure-
ments was found to reach :
3 mm in 1 case.
4 mm in 1 case.
5 mm in 3 cases.
6 mm in 5 cases.
Total 10 cases.
Among the 50 cases of the second column in the table :
3 mm in 1 case.
4 mm in 1 case.
6 mm in 2 cases.
9 mm in 1 case.
Total 5 cases.
Thus, frontal asymmetry is twice more frequent among the in-
sane, although its maximum degree, of 9 mm., is found in the
normal.
The averages of the ophrion-tragus diameters are :
In the 50 insane 1 19.40 mm.
In the 50 normal subjects chosen according to the
longitudinal cranial measurement 118.25 mm.
In the 50 normal subjects chosen according to the
transverse cranial measurement H7-65 nim.
In the 325 subjects from Riaziansk 118.60 mm.
There is only one maximum figure of 140 mm. in the case of an
epileptic with dementia ; and he has a hydrocephalic head.
As is seen, the insane show a maximum measurement of the
ophrion-tragus diameter ; but it would be wrong to conclude, with
some others, that the insane present a higher frontal development.
In these cases, the fact may be due to the condition of the larger
stature of the 50 insane subjects. It is fitting to conclude that
there is no essential difference between the frontal measurements
in the normal and in the insane subjects.
A CONTRIBUTION TO THE STUDY OF ACUTE
DELIRIUM. A PSYCHIC DISEASE OF SCOR-
BUTIC ORIGIN, H/EMORRHAGIC
ENCEPHALITIS OF STRUMPEL.
BY DR. BENJAMIN SEMIDALOW, MOSCOW.*
The subject of this disease has been treated of at length by
many authors and the reader will be spared the reading of its
bibliography here. Dr. Veidengammer and myself and Dr.
Broukhansky have demonstrated recently that the causative basis
of acute delirium is a hemorrhagic inflammation of the cerebral
cortex, and that the mode of onset of the disease has the character-
istics of an infectious disturbance. Our views coincide with those
of others who have studied the subject and among the most recent
workers, Beinswager and Beranger (i) hold my views in this
respect.
The variety of individual symptoms depends on the clinical
conditions of the case and a high temperature at the onset is gen-
erally indicative of an infectious origin. The rise of temperature
found in the large majority of cases at the height of the develop-
ment of the disease may be considered as being due to the circula-
tion of debris in the blood vessels caused by hypermetabolism of the
tissues. The disturbances of consciousness and muscular move-
ments as well as the paralytic phenomena are of essential signifi-
cance in the diagnosis of acute delirium. The case cited below is
exemplary of this affection. The point of interest here is that the
patient made a recovery — an uncommon end of this affection.
M. N. A., widow, 55 years old, entered the Alexeievski psychi-
atric hospital July 17, 1899. The full history of the case cannot
be had, but it is known that the patient's mother died of a psycho-
pathic disease. The patient herself has never had any psychic
disturbances, is not an alcoholic and has never had syphilis. In
the quality of a hospital nurse she was assigned to take charge of
a military sick ward in the Kazansk Department, where scorbutus
was prevalent at that time, in 1898. The patient was given every
* Simultaneous publication in the Journ. S. S. KorsakOwa.
14 ACUTE DELIRIUM.— Dr. Semidalow.
luxury of life possible, as she was an officer's wife, and during
leisure hours she was out in the fresh air ; besides, she was isolated
from the scorbutic wards during the last few months before her
illness. Nevertheless, she showed symptoms of scorbutus on July
I ; there were hemorrhagic effusions about the right ankle and
then about the left one; the temperature rose to 38.5 degrees C.
On July 13 the haemorrhages had disappeared, leaving oedema of
the feet. But the patient began to show signs of psychic distur-
bances at about the tenth of July. She became highly irritable
and unusually stringent with her inferiors, and made severe
threats to those about her. On July 13, the patient showed a de-
cided psychic disturbance, as she did not recognize persons well
known to her ; there was also a lack of judgment of time and space
and she was unable to give any account of herself. She had
many illusions of sight and hearing and spoke incoherently. Hal-
lucinations of smell followed and she refused to eat or drink ; she
became filthy, urinating in her clothes, and there was also urinary
retention; she suffered from insomnia and marked constipation.
On the 15th, slight convulsions were noticed about the face and
left arm and there was exaggerated muscular activity. On the
17th, she uttered neologisms in a rhythmic manner. The physical
examination showed that she appeared anaemic, the gums were
spongy, but the teeth seemed firm in their sockets ; the mouth was
filled with blood and there was an excessive salivation and a
slight scorbutic odor. The pupils were equal in size and reacted
to light and accommodation. The knee reflexes were normal and
there seemed to be nothing wrong with the internal organs. The
urine was free from both sugar and albumen. The knees were
the seats of bloody extravasations. The temperature was 37.8
degrees C, the pulse feeble and rapid and the cardiac beats weak.
The patient rambled in an incoherent manner and did not reply
to questions addressed to her. She kept her eyes shut and her
arms in the air, the fingers distended, executing rhythmic move-
ments. If the hand was held a while, the movements stopped,
but were resumed as soon as the restraint was released. The
swallowing was difficult. On the 17th, the temperature was 37.7
degrees C, and she refused to eat, talking incoherently, with
marked disturbances of articulation. On the 21st, the temperature
was 38.4 degrees C, and numerous hemorrhagic spots made
their appearance on the chest and hands ; the size of those spots
was about that of a ten cent piece. The restlessness and incoher-
ent speech and movements continued. Artificial feeding was con-
tinued. On the 23d, 24th and 25th, the general restlessness was
exaggerated and there were facial and general muscular tremors
ACUTE DELIRIUM.— Dr. Semidalow. IS
and convulsions. The head inclined to the right and the eyes in
the same directions. Within the short period of this illness the
patient lost 22 kilogrammes in weight. From July 26th to August
3d, the rhythmic movements of the limbs diminished gradually, the
tremors also decreased in intensity, but she suffered intense head-
aches and when made to walk it was noticed that the gait was
paretic. The condition seemed to tend towards a favorable issue,
however, although she showed marked mental confusion with
various delusions and hallucinations of sight and hearing. On
August 25th, the physical and psychic conditions were decidedly
improved, although her memory was quite defective; she did not
remember how she had been brought to the hospital nor to Mos-
cow. As soon as her memory became clearer, however, she imag-
ined that she was living through the period of the Twelfth year,
that the French had invaded Moscow, that she was threatened
with death, etc. On September 9th, her condition was much im-
proved and the slight difficulty in walking disappeared completely
towards the end of that month.
From a clinical standpoint, the rapid development of the symp-
toms is to be noted. Then there are two distinct periods in the
course of the disease ; the first includes the initial period of general
irritability and the second is marked by a sudden onset of obscured
consciousness with motor disturbances. The latter period had its
accompanying symptoms of convulsive and rhythmic movements,
tremor, transitory strabismus, difficulty in swallowing and speech,
retention and incontinence of urine and refusal of food. The first
half of this period was also noted by an elevation of temperature,
38.4 degrees C. being the maximum. The second half is charac-
terized by psychic manifestations, principally, which might be
considered as belonging to the type of amentia. During the
course of two weeks, these symptoms declined gradually and
progressively.
From a diagnostic standpoint, this case did not suggest any
form of amentia even when the psychic disturbances were at their
height. Every symptom pointed towards an acute disease of an
inflammatory nature, located in the cerebral cortex or, in other
words, towards an acute cortical encephalitis; while the clinical
tableau was distinctly that of acute delirium. Alongside with
that were signs of focal lesions, as shown in the case. With these
symptoms our case may be considered as one of a transition type
between encephalitis of acute delirium and encephalitis of the
type Strumpell. Such a transition is possible, and among the
authors who support this view are Oppenheimer and Bree (2).
Khmelevski reports a case of the variety in which acute delirium
l6 - ACUTE DELIRIUM.— Dr. Semidalow.
was followed by symptoms of focal nature ; the case reported here
demonstrates the possibility of the reverse occurrence of symp-
tomatic development.
Indeed, the history of the case shows that 10 days after the
onset of the scorbutic signs, symptoms of acute delirium were
fully developed ; while these were in progress, scorbutic signs set
in anew ; there were seen subcutaneous haemorrhages, of a newer
date. With this knowledge, the infectious nature of the acute
delirium cannot be doubted, and there is every reason to hold the
view that the cortical encephalitis was caused by the specific scor-
butic infection.
Prof. Levine has described the scorbutic bacillus (3). It be-
longs to the group of septic haemorrhagic bacilli and the author
calls it bacillus haemosepticus.
It is of interest to note that on the day when the subcutaneous
haemorrhages took place, the patient's temperature rose and the
symptoms took on a severe nature.
The favorable end of the disease in this case precludes the
citation of the anatomical pathology that must have existed. Re-
searches in fatal cases of this kind show, beyond doubt, that the
disease is based on an infectious haemorrhagic encephalitis. The
cases observed by Amelevski, Joukovski, Popov, Veidengammer
and myself confirm the view held here (4). The pathological an-
atomy of two recent cases (Veidengammer and Broukhansky)
showed the following : Hyperaemia of the blood vessels of the cor-
tex and its envelopes, disseminated haemorrhages, infiltration of the
vessel walls, thromboses, and infiltration with lymphoid elements
in the pericellular spaces in the cortex. In Siemerling's case of
acute delirium (5) there were also found haemorrhagic foci in
the cortex. In the recent work of Beiswanger and Berger, two
cases of acute infectious psychoses are reported which termin-
ated by lysis and there was found extended degeneration of the
spinal and cortical cells, acute degeneration of the myelin fibres,
hyperhaemia and white cell emigration. Both cases are consid-
ered by the authors as those of acute encephalo-myelitis of an in-
fectious nature.
The more the disease is studied the more it is recognized as
being an infectious disturbance characterized by identical an-
atomical lesions. From the etiological and anatomo-pathological
standpoint, the disease must be classed as an individual affection ;
it cannot be confounded with idopathic amentia.
Acute delirium is one of the severest cerebral affections al-
though there are some cases of recovery now and then. Some of
these may come out dements. These may be compared to Oppen-
ACUTE DELIRIUM.— Dr. Semidalow. 17
heimer's cases which he terms as primary encephalitis and in
whom mental improvement took place within a certain period of
time, others having made a complete recovery. Brie speaks of
cases where the inflammatory process is less severe, the develop-
ment of symptoms more moderate and where the inflamd foci dis-
appears through gradual resorption recovery being thus estab-
lished. It is probable that our case was one of a similar nature.
REFERENCES.
(i) Arch. F. Psych, und Nerv., 1901.
(2) BREE. Ueber einen Fall von primaerer acuter Encephalitis haem-
orrhagica. Neur. Centr., 1897, No. 1.
(3) Researches on the etiology of scorbutus. Arch. Biolog. Naouk, T.
VIII., 3d series.
(4) VEIDENGAMMER AND SEMIDALOW. Journal of Mental
Pathology, Nos. 3, 4-5, 1901.
(5) Berlin. Klin. Woch., 1899, No. 32.
EXPERIMENTS ON THE MOTOR PRECISION
OF THE SANE AND THE INSANE.*
BY DR. CARLO SCAPPUCCI, ITALY.
I have made numerous experiments in Dr. Ferrari's psychol-
ogical laboratory (Psychiatric Institute of Reggio-Emilia) for the
purpose of determining the degree of the practical value of the
Mental Test suggested by Drs. Guicciardi and Ferrari, in 1897.
The test consists of an analysis of motor precision of the insane.
I have examined fifty men and fifty women patients (Reggio-
Emilia asylum) who are suffering from various forms of psychic
diseases, and have compared the results obtained with those of
another series of identical experiments on fifty men and women,
respectively, who were in perfect mental as well as physical health,
of as nearly the same age and education as were the insane sub-
ject.
A brief description of the experiment is as follows :
A copper plate is covered with one of ebony; the latter is
134 mm. long, 65 mm. large and 4^2 mm. thick. This upper
plate has thirty holes, which are disposed regularly in three lines ;
the largest hole is marked by the figure 30 and measures 10 mm.,
while the smallest hole is marked by the figure I, through which
a dissecting needle can pass with difficulty. The needle is put
into a holder, placed at a distance of ten centimetres from the
plate with the holes, and the subject is asked to put the point of
the needle into every hole of the plate, beginning with the largest
and ending with the smallest. Both the needle and the copper
plate are connected with a Grenet coil and an electric bell, so that
every time the needle touches the copper plate through the holes
in the plate above an electric contact is established and the bell
rings.
A small indicator shows how many times the subject has tried
to pass the needle through the hole and the experiment is com-
pleted after the subject has tried 20 times for every hole. The
number of failures to pass the needle through the holes was
marked on a special chart which gave the curves as seen in the
tables.
* Simultaneous publication in the Rivista Sperimentale di Frenitria, Vol.
XXVII.
MOTOR PRECISION.— Dr. Scappucci. 19
The right hand of the subjects was tried first, then the left
one; besides, every subject was submitted to two experiments, at
from five to ten days' interval between them, according to the
case, so that there were four tracings which represented the ex-
periments on every subject. In all, two hundred subjects were
examined; fifty men, healthy and insane, respectively, and fifty
women, also of the same category. There were, therefore, six-
teen graphic tracings in all, showing the motor precision in the
subjects. The tracings which accompany this study are composite
in nature. The tracings expressive of the motor precision of the
right and left hands, respectively, in the fifty normal men, are
represented in four charts ; those expressive of the motor precision
of the right and left hands of the fifty insane men are represented
in another set of four charts; the motor precision of the fifty
healthy and the fifty insane women is similarly expressed in com-
posite charts — four for each group.
The composite charts were constructed as follows:
Every grahpic point on the charts represents an arithmetical
average of the failures made by the fifty persons in their attempts
to put the needle into a given hole, for instance, by the fifty right
hands of the healthy men during the first experiment, or the fifty
left hands of the insane women during the second experiment,
etc. The number of the corresponding holes is marked at the
bottom of the chart, while the number of failure to put the needle
into a given hole is marked at the left hand side of the chart. To
be more explicit, an addition was made of all the errors committed
by the fifty persons, the motor precision of whose hands, right or
left, was tested, during the first or second experiment in touching
the hole with the needle; the figure thus obtained by addition
was then divided by fifty and the fraction obtained was marked
graphically on the chart. Thus, for instance, there is marked
graphically 3.2 in relation to 12 at the base line of the first chart;
this implies that fifty healthy men, experimenting with the right
hand for the first time, made, altogether, 152 failures, or that, on
an average, they did not succeed in putting the needle into the
hole which corresponds to number 12 until they had made three
attempts (and a fraction), as 152 divided by 50 equals 3.02.
The tracings are arranged so that the first four represent the
experiments on the healthy men, D. indicating the right and S. the
the left hand; 1, indicates the first and 2, the second experiment.
The next four tracings represent, in the same order of succession,
the experiments on the insane men. The tracings of the experi-
ments on the healthy and the insane women are arranged in a
similar manner.
20 MOTOR PRECISION.— Dr. Scappucci.
I have had occasion ( i ) to point out the advantage of individ-
ual psychological study in the matter of the examination of motor
precision in general : I have not yet had time to investigate the
vast material furnished in this line of work and I limit my
present communication to this cursory sketch.
I shall analyze the homologous tracings, first, that is to say,
those relating to the hands of the same denomination of subjects
of a given group, in order to compare the results obtained during
the first and second experiments respectively.
In the tracings I and III, and II and IV (healthy men) it is
seen that the curve for the left hand expresses more accidents than
that for the right one, and that, while there is a lowered level
and a more marked regularity in the tracings of the second
experiment for the right hand, the tracings of the left hand show
a lowered level only, the regularity remaining almost unchanged.
The contrary is found in the tracings of the experiments on
healthy women, as seen by comparing tracings IX with XI, and
X with XII. Here, indeed, it is seen that the general level of the
curves is not lowered to any extent in the second experiment, but
their regularity is more noticeably marked, especially on the right
hand side of the tracings.
In the insane (both in men, fig. V-VIII, and in women, fig.
XIII-XVI), on the contrary, the improvement with the repetition
of the experiments is but slight, as seen from the fact that the
general level of the curve slightly lowered, and this lowering of
the level is almost limited to the tracings of the experiments on the
men only (fig. V-VII).
This fact would seem to carry no importance with it, the insane
being characterized by irregularity, were it not for the truth that
there seems to exist a certain regularity in this very irregularity ;
by superposing one tracing upon the other, of an homologous
denomination, the respective lines seem to coincide with one
another in a remarkable degree, if not in the matter of precision,
at least in that of number and general aspect.
In men and women of normal health this regularity is less
marked ; but it seems to exist to a noticeable degree especially in
the left hand; this fact explains itself — the left hand being the
least differentiated of the two.
The regularity referred to is not too obvious because of the
complexity of the experiment, but the existence of the former is
sufficiently constant to be looked on as a phenomenon beyond
purely accidental occurrences and deserves to be brought to light
for further study.
(i) Rivista Sperimentale di Freniatria, Vol. XXVII.
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1 /•- ^<
it X^
4X h-E^ 4-
v* ±Zl
i 4
4_ , _ 4. __._ ._
LL_ .l. J _ _.. ....
FIG. XV.
FIG. XVI.
EXPLANATION OF INSCRIPTIONS ON CHARTS.
Uomini sani healthy men
" malati (slck) yj*ane men
Donne ,ane y ■■• --healthy women
" malate («<*) ms^e. ^frf
M. D n?hI £??*
M. S •
.left hand
THE GENESIS OF EPILEPSY CLINICALLY CON
SIDERED— THE PATHOLOGY, PROPHYLAXIS
AND TREATMENT OF EPILEPSY.*
ILLUSTRATED BY CASES AND STATISTICAL TABLES,
BY LOUISE G. ROBINOVITCH, B. ES L. (PARIS), M. D.
Foreign Associate Member Medico-psychological Society, Paris; Member New York
Academy of Medicine.
I.
Epilepsy is best studied in clinical work. — The study should
begin with the analysis of vertigo of alcoholic nature and should
follow the successive stages of pathological development in the
parent and the consequent manifestation of epilepsy in the off-
spring.— Epileptiform convulsions of alcoholic origin are the step-
ping stones to epilepsy in the offspring. — Clinical illustrations.
The study of epilepsy should consist not only of the study of
that branch of science whereby the obscure nature of the disease
is analyzed after death, under the microscope, but also of clinical
work, by which its manifestations during life plainly point out the
means for combating the affection. The disease is best studied
and easiest understood when analyzed in its simplest forms.
For the sake of clinical simplicity, let us begin with the study of
vertigo, a frequent substitute or accompanying phase of epilepsy.
Under what circumstances does vertigo generally take place?
What causes it? Can it be induced or stopped at will when the
cause is easily induced or removed ? When vertigo is followed by
a severer clinical element — a convulsion, can this be stopped or
induced again, at will, by inflicting or removing the cause?
When the cause is allowed to ravage the system and to induce
convulsions in a subject, what happens to the subject's offspring —
the ready borrower of so many intimate parental traits ? Does the
parent have to be afflicted with a convulsive disease in order to
transmit it to his offspring, or is the specific cause of epilepsy so
* An abstract of this paper was read at a meeting of the medical section
of the New York Academy of Medicine, Dec. 17, 1901.
GENESIS OF EPILEPSY.— Dr. Robinovitch. 25
far-reaching in its determination of cerebral changes in the parent
that the latter may transmit a convulsive disease to his offspring
while he himself remains free from the disease ?
These difficult questions will be examined in a manner that will
lead from the simple to the complex and will show the cause and
effect.
Let us pay attention, first, to the clinical phenomena of alco-
holism which are so often accompanied by vertigo and convulsive
symptoms.
THE ACTION OF ALCOHOL ON THE HUMAN BRAIN.
What influence has alcohol on the human brain when there is
simple intoxication? The question will be answered by a clinical
demonstration which speaks in more eloquent terms of description
than can mere words.
Case I. — Acute alcoholism. — Hallucinations of sight and hear-
ing.— Disturbances of general sensibility. — Attempted suicide. —
Mental degeneracy.
E. A., 27 years, was admitted to the Admission Bureau, Ste.
Anne asylum, May 21, 1899. The history of the patient is wanting
in essential information. The patient was born in Russian Poland.
He has always been of a nervous temperament, impressionable
and sensitive. He devoted most of his time to the study of the
Fine Arts, and even distinguished himself as a student at the War-
saw School of Fine Arts. At the age of nineteen, he left his
country and came to New York. He had no difficulty in finding
remunerative employment in his professional work and was paid
eighty dollars a month by a leading commercial house here. He
soon tired of the occupation and entered a law school. There he
remained six months and again changed his occupation. He
worked for a well known life insurance company in New York,
made a good record for himself, earning some three hundred dol-
lars monthly, he alleges. He remained with this company three
years and then entered into business relations with another com-
pany which offered him better terms. There he remained fifteen
months, earning four hundred and fifty dollars a month, he says.
About that time the patient began to imagine that people envied
him, that they were jealous of his success, that they prejudiced
the company against him, and that he was being watched. After
some months of this morbid suspicion, he finally visited the office
of the company and created a disturbance. He was arrested, was
taken to Bellevue Hospital and was soon transferred to a private
sanitarium; he submitted to this under protest and managed to
26 GENESIS OF EPILEPSY.— Dr. Robinovitch.
make his escape after the third month of his stay there. He left
New York for Germany, where his parents came to see him, but
after a short visit he tired of the quiet life and went to England
to resume work. This was in August, 1898. Meanwhile, he wrote
and published a book on a philosophic question of life and the pub-
lication had sufficient success to warrant its dramatization by the
patient himself. He began work for a London branch of the life
insurance company before mentioned, but his delusions soon re-
asserted themselves ; the company had a grudge against him and
paid an army of people to watch him and to poison him. Did he
drink a glass of milk — it was full of poison ; did he eat a beef
steak— he could taste poison in it. He began changing restaurants,
but with no result; there was poison put into the food, wherever
he bought it. He then decided to hurry away from England, to
some country where he could live unobserved. Montreux, Switz-
erland, was decided on. No sooner was he on the train than the
company's "spies" were at his heels. This was intolerable; he
jumped at a man in the car, thinking he was one of the spies. At
the nearest station E. changed to another train in order to escape
his persecutors. He took an extra precaution, on reaching the
continent, by stopping at Paris, instead of going straight to Mont-
reux, as he had intended doing. As he could obtain no room at the
Grand Hotel and was obliged to engage one in a smaller place, he
concluded that the company had followed him to Paris and spread
bad information about him. He, therefore, engaged a guide, told
him of the persecutions and begged him to extend him protection.
The guide took the patient around to show him the city ; absinthe
and rum were indulged in freely, the guide declaring that there
was no poison in those drinks. After some few days of these in-
dulgences, the patient became severely intoxicated and was
brought to his hotel in a condition of mental excitement. The
night was spent restlessly, acute gastric disturbances keeping E.
awake; there were also hallucinations of sight and hearing.
He was taken to the Infirmerie du Depot and thence brought to
the Admission Bureau at the Ste. Anne asylum. Here he had most
marked facial pallor, trembling of the hands and profuse perspir-
ation of the whole body. When put to bed he shrieked with
fright, fearing that he was going to be killed by those around him.
When I approached his bed he mistook me for his sister and called
me by her name. He held on to me, crying and shrieking: "Oh,
for heaven's sake, do not leave me; they are going to chop your
head and mine off. They have filled me with poison up to my
throat ; my stomach is full of burning coal ; everybody's head will
be chopped off." And grappling with the attendants who tried to
GENESIS OF EPILEPSY.— Dr. Robinovitch. 27
calm him, he cried: "Oh, it is horrible, horrible; look" (pointing
to the trees in the yard) "oh, this horrible place; it is a wilderness
where human blood floods the earth, permeates the air and sub-
merges the trees ; look at those heads hanging from the trees — at
those innocents being killed." He beat his head against the wall
and bedstead, crying that he wished to kill himself rather than
be beaten to death by "those beasts." Every touch by an attendant
made the patient try to jump out of bed, he imagining that an axe
was chopping his flesh ; every look of those he noticed frightened
him ; every one was actively engaged in wholesale manslaughter,
the blood flowed in rivers from all sides, his own bed and body
were the fountains of bloody streams ; his sheets were red, saturated
with blood; bleeding heads were hanging over him, and bloody
animals were creeping over his skin. He tasted the blood ; it stuck
to his tongue, it was everywhere, on everything ; it glued his fingers
together and stuck between his teeth. A few days and nights of
this painful fright and constant agitation finally exhausted him ; in
despair he took hold of his tongue and pulled it with all his might,
trying to tear it out and "get done with the butchery" rather than
be tortured, as he was in his imagination.
The condition of the patient was a serious one, for, besides the
disturbances described, he suffered from fever that pointed to a
pulmonary lesion ; and, indeed, on examination some induration
was found in the pulmonary apex. He was sinking rapidly, but a
careful and tender nursing brought him out of danger. It was
some weeks before the last delusions left him, as delirium of
degeneracy was intimately intermixed with the alcoholic delirium
properly speaking.
The early effects of alcohol on the brain are, then, an acute
generalized excitation of the cerebral nervous cells; this is dem-
onstrated by the manifestation of the transitory psychic symptoms
which disappear with "the last vapor of the alcohol" (Magnan) .
After such an attack, if no repetition of ingestion of alcohol takes
place, the transitory psychic disturbances may be of no consequence
to either the subject himself or his offspring, as will be shown
further on. The case becomes a grave one, however, to both par-
ent and offspring, when the indulgence becomes a chronic habit.
Before even the parent falls victim to any convulsive attacks the
child, conceived during a period when alcoholic excesses are in-
dulged in, may be brought into the world with a deep rooted stigma
of pathological nature. Such an offspring may die of meningitis
a few days or weeks, or perhaps months, after birth ; or else, the
child may become an epileptic, with or without accompanying
psychic disturbances.
28 GENESIS OF EPILEPSY.— Dr. Robinovitch.
The case below shows the relation between parental alcoholism
and pathological descendency.
Case II. — Alcoholism. — Hallucinations of hearing and sight. —
Delusions of persecution. — Disturbances of the general sensibility.
— Attempted suicide. — Two children born before the father ac-
quired the alcoholic habit, are healthy; but two children born after
that period died of meningitis during infancy.
M. J., 39 years old, was admitted to the Admission Bureau Ste.
Anne Asylum, March 29, 1899, an<^ *s a mechanician by trade. His
father died of pulmonary disease and his mother died of heart
disease. One sister, 34 years old, is a nun ; one brother, 37 years
old, is healthy and gains his livelihood by shoemaking.
The patient always enjoyed good health, married when he was
23 years old and was steadily employed in his trade. Up to eight
years ago he did not indulge in alcoholic drinks. Two children
were born in that time and both are healthy. Eight years ago he
lost his position and worried about it. He began to indulge in alco-
holic beverages with a view to "cheering up," he says. He did not
drink every day, but only now and then. After indulging freely in
drink he would suffer from gastric disturbances and night-mares ;
but a period of sobriety after this always restored him to his usual
health. At times he indulged in drink quite freely, however, and
the clinical manifestations were more marked; there was mental
depression, slightly marked hallucinations of sight and hearing.
He was now taking three quarters of a litre of wine daily, from
three to six "absinthes," and some rum, now and then. In January,
1899, after having indulged in drink, he had hallucinations of
hearing, and delusions of persecution of a painful nature. He
heard voices telling him that he would be thrown into a well, that
the Pope had condemned him, that his heart would be torn out,
that Jesus Christ needed it. The patient was pursued by imaginary
enemies, from whom he tried to escape. "My nerves were creep-
ing crosswise" (les nerfs me marchaient de travers), he said. This
sensation he attributed to a mysterious action of a telephone beyond
the walls of his room. He pulled his "nerves" in order to become
free from the pain they gave him. The "nerves said" to him all
sorts of things and "made him" sing songs (ca me disait toute
sorte de choses ; ga me faisait chanter des chansons). He grabbed
an iron bar and attempted to demolish the wall and the telephone
which made him do those unusual things through the medium of
the "nerves."
He was taken to the Ste. Anne Asylum and from there trans-
ferred to the Ville-Evrard Asylum. The delirium soon subsided
GENESIS OF EPILEPSY.— Dr. Robinovitch. 29
and the patient was given his liberty. He resumed his alcoholic
excesses, however, and soon had another attack of alcoholic
delirium. He was persecuted and heard a voice tell him : "I want
to shoot you with a revolver." He continued drinking, preferabl}
absinthe. "I imagined," he says, "that there was always some one
behind and close to me, that by means of a machine, people knew
all my thoughts, that I was in a prison and that prisoners were
being brought in secretly and put in secret cells. This made my
mind suffer so that I wished I could be without a mind, to think
of nothing — so much did the thought tire my head. I heard a
weird sort of music that a machine repeated. People wished to
kill me; they were hidden beyond the wall, the attendant from
Ville-Evrard and his comrades had come to me, and were partic-
ularly bound on taking my life. I heard their voices to that effect.
Many a time I got out of bed during the night, all afright and on
the defensive against the murderers who were tormenting me. In
the morning I took my breakfast, but was enervated by the ma-
chine beside me. Finally I could stand this no longer and cried
out : "As they wish my life, there it is (puisqu'ils veulent ma peau-
la voila) and I threw myself from the window."
On the occasion when he acted in that manner, his wife had run
into the room and reached him in time to catch him by the foot.
"Let go, let go" (lache, lache moi done), he had cried to her, as
he felt the hold and heard her crying for help. No one had come
to the rescue, and the wife, too exhausted to sustain the weight
of the suspended man, had finally loosened her hold and the pa-
tient had fallen from the third story. An arm, one leg, one foot
and several ribs were broken and he sustained many contusions.
Within the course of a month, his delirium had completely disap-
peared. He spoke rationally and coherently, showing no traces of
the psychic storm he had gone through.
Tzvo children born during the last eight years died in infancy of
meningitis.
In summing up the clinical picture of acute alcoholism Dr.
Magnan says: "By the sense of sight: he imagines that he sees
numberless animals, thieves, assassins; he sees the most
crushing scenes; he sees himelf in the midst of flames,
on the gallows. By the sense of hearing he imagines that he hears
insults, threats, accusations against his honor, morality; he hears
groaning, plaints, cries, clashing of arms. By the sense of smell :
the most obnoxious smells surround him, suffocate him; he
breathes in a pestilential atmosphere. By the sense of taste, there
is nothing too nauseating, nor too poisonous for him to taste.
Finally, by the sense of touch, he imagines himself subject to the
30 GENESIS OF EPILEPSY.— Dr. Robinovitch.
most frightful punishment ; he feels the sharp point of the blade
penetrating his flesh, mutilating it frightfully, or else it is the
creeping of a serpent on his skin, encircling him; insects and
worms gnaw his body that is falling to pieces ; clouds of flies pen-
etrate into his mouth, nostrils and eyes ; or else, he is drowning or
being thrown into a chasm.
"Under the influence of these hallucinations, the unfortunate
patient reacts in different ways. He becomes excited, defends him-
self, strikes, or remains immovable, crushed, stricken. His vari-
ous attitudes result accordingly; he is maniacal, melancholy,
stupid; all the attitudes have their origin in the same cause, but
vary according to the degree of intensity of that cause. A suc-
cessive gradation is observed in the development of these phe-
nomena." (i)
The immediate effects of alcohol on the brain may disappear, as
already stated, within a greater or lesser length of time, leaving
no pathological traces in the cerebral tissue, if the repetition of
the attack is prevented. But the patient who persists in satisfying
his morbid craving for alcohol fares less fortunately ; the transitory
tempest produced by the toxic agent is then not the only patholog-
ical result ; the delicate cerebral tissue, fed on a poison that does
not fail to imprint its indelible mark, soon becomes the seat of
grave anatomical changes. Clinically, the more permanent im-
print of the effects of alcohol on the brain tissues is expressed, in
addition to the muscular tremor, acute delirium and disturbances
of the senses, by another set of symptoms that are grave in their
nature, being the result of pathological phenomena.
"At the end of some years of continued alcoholic excesses, when
the chronic alcoholics begin — allow me the expression — to become
ripe, that is to say, sufficiently intoxicated — their intelligence be-
comes enfeebled, the memory diminished, the imagination dulled,
the thinking power slowed, the judgment less firm, the moral and
affective faculties more lax ; the patients become apathetic, indiffer-
ent, with less of will power, other than that necessary to satisfy
their instinctive appetites. At that period appear also vertigo,
formication and cramps in the limbs, small apoplectiform attacks
are followed, now by a temporary paresis of an arm or a leg, now
by thickening and difficulty of speech." (2)
In our study of the genesis of a convulsion from a clinical stand-
point we have, thus far, been enabled to observe the preparatory
step in the brain. One step higher, one more degree of morbid
(1) MAGNAN. Recherches sur les centres nerveux, p. 14, 1896.
(2) MAGNAN. Recherches sur les centres nerveux, p. 52, 1896.
GENESIS OF EPILEPSY.— Dr. Robinovitch. 3*
changes in the cerebral tissues, and we shall witness the next path-
ological step consequent on the use of alcohol ; that step is char-
acterized by the appearance of vertigo ; the latter may be accom-
panied by an occasional convulsive manifestation.
As for the offspring conceived at that stage — they are generally
born with a condition of cerebral pathology far exceeding that
found in their parent. The diseased tissue in the parent has now
become twice diseased in the child. The pathological cerebral
change in the parent which is expressed clinically by a mere
vertigo, is in the child, born at this stage of evolution of parental
chronic alcoholism, manifested by far more severe symptoms.
These may range from simple convulsive spells to the most pro-
found psychic degeneration, such as idiocy, imbecility, criminality,
porencephalus, accompanied or not by palsies, and varied other de-
formities both of mind and of body ; alcoholism and other morbid
appetites are frequent manifestations in such descendency.*
A glance at any clinical record sustains all that has just been
said, as is shown in the case below.
Case III. — Chronic alcoholism at the time of marriage. — Hallu-
cinations of sight, hearing and taste. — Delusions of persecution. —
Vertigo. — Epileptiform attacks, repeated attempts at suicide. —
Pathological record of eleven children born; among the diseases
of the latter are: Meningitis, convulsions, drunkenness and St.
Vitus' s dance.
M. P., 65 years old, was admitted to the Admission Bureau, Ste.
Anne Asylum, June 28, 1899. There is no pathological record in
Tiis family either on the maternal or paternal side. His mother
died at the age of 84 and his father at the age of 55 years. The
brothers and sisters are healthy. The patient has been married 43
years and his wife says that he has been drinking since she first
lcnew him. Eleven children were born, whose record is : Four
children died of meningitis, two twins died when one month old,
one child died at eighteen days, and another at six months, both
the latter from "convulsions." One son died a drunkard at the
age of 35. Two children only are living: One girl, eleven years
old, has St. Vitus's dance, and a boy, three years old, has not yet
shown any gross pathological symptoms.
* Vide : Dr. Robinovitch. The relation of criminality in the offspring to
alcoholism in the parent. A clinical study. Read before the International
Congress of Psychiatry, Paris, 1900.
Dr. Robinovitch. Idiot and imbecile children. A clinical study. The
Journal of Mental Pathology, Nos. 1 and 2, 1901.
32 GENESIS OF EPILEPSY.— Dr. Robinovitch.
The patient has been indulging to excess in alcoholic beverages
since his adolescence. At the time he was married, in 1857, he
was already suffering from attacks of giddiness and vertigo. He
was hardly ever sober, his lifetime alternating between the con-
ditions of chronic alcoholism and spells of acute exacerbations.
During the latter periods he suffered from hallucinations of the
senses and had delusions of persecution: His wife was deceiving
him, was unfaithful; people pursued him, tried to kill him, to
strangle him, to poison him. He heard his enemies, he could see
them, his food and drink tasted of poison and he refused to partake
of either. His wife was in a plot with his persecutors and he beat
her. At various times, frightened by the pursuit of imaginary
enemies, he cried for help and attempted to jump from the win-
dow, or down the staircase. Since his wife has known him he has
been suffering with cramps in the legs, arms and stomach, night-
mares and vomiting in the morning, dizziness, vertigo and occa-
sional small cerebral apoplexies which were followed by slight
muscular paresis, now of the face, of an arm, of a leg, or of the
tongue. The memory as well as the intelligence weakened grad-
ually but progressively, and he fell, at times, into convulsive epilep-
tiform attacks. On one of those occasions he broke his leg. When
regaining consciousness he was astonished to find himself with a
fractured limb ; he was totally unaware of the circumstances under
which the accident had taken place. On July 14, 1895, he cele-
brated the national holiday by indulging heavily in alcoholic ex-
cesses. While thus at table, drinking, he suddenly fell in a con-
vulsive attack. He lost consciousness and remained in that con-
dition during a period of eight days. After recovering from the
attack he resumed the alcoholic habit. The convulsive attacks
thereupon became more frequent, and assumed a more decided
character. In May, 1897, he had another severe epileptiform at-
tack and fell unconscious to the ground, breaking his leg for tnt
second time. The accident was a blank to him; he knew of the
occurrence only from what he had heard his wife tell him about it.
At this time, his memory as well as his intelligence had become
lowered far below the normal, and he was little more than a
dement.
Only now, when his mental as well as physical strength were
reduced to their minimum, was the wife enabled to control his
habits and prevent him from further indulging in alcoholic drink.
A permanent injury had been done to the brain, however : although
forced to abstain from alcohol during a period of fourteen months,
the patient's intelligence remains impaired, the memory reduced
and weakened, the whole muscular structure making no exception
GENESIS OF EPILEPSY.— Dr. Robinovitch. 33
to the generalized ravages; the speech is thick, heavy, uncertain,
the eye is dull, the whole being is tainted with the disastrous
storm of years of self imposed poison. Recently, on recovering
from an epileptiform attack he took a knife and cut his wrist.
When recovering consciousness he saw the wound and knife with
which he had inflicted it, but he was astonished to see both; he
knew nothing of the manner in which the deed had been accom-
plished. When brought to the asylum for treatment, he presented
the condition as below : Dulness, no memory, forgetting what was
said to him two minutes previously. When asked about the loss of
his memory he said in indistinct utterance : "It is queer how I am
losing my memory." (C'est drole que je perds la memoire). He
has vague delusions of persecution, imagining that people wish to
kill him, that his food tastes of poison, that his wife puts poison
into the food given him; the attendants are bartenders and refuse
to give him drink for spite. Grieved with these painful delusions,
he cunningly managed to find a razor and cut his throat. He was
surprised in time, however, and an injury to the large vessels was
averted. "It was a pity," he said, that he was caught in the act,
"for the poison was still being put into my food." At two different
times he has shown excessively painful delirium, moaning and
shrieking by day and night and refusing to swallow any food. The
tongue was dry, the lips were parched, the eye haggard; he
lamented and tossed in his bed, trying to rid himself of the enemies
and the poison.
The laboratory experimentors and investigators bring us valu-
able help in the difficult matter of solving the problem of the gen-
esis of epilepsy. The researches on the diseased brains, by bio-
pathological analyses, by the study of patho-physiological phe-
nomena and psycho-pathological manifestations, as well as by
microscopic investigation, cannot be over-estimated as helpful aids
in this work. It is a question, however, as to how far the prac-
tical side of the subject, that of eradicating the disease, will thereby
be benefited if the simple study of the fundamental principle of
the causation of epilepsy is neglected and sacrificed for the study of
the higher and more complex phenomena that characterize this
disease.
In clinical work, on the other hand, one has a more valuable
expose of the genesis of epilepsy than is found in experimental
research. In the clinic, one has a great advantage over the path-
ologist in the laboratory. The clinician can trace the development
of epilepsy throughout its subtlest steps, following the malady from
its simplest morbid element to the complex. Laboratory work is
reduced, for obvious reasons, to discovering the grosser and mos|
34 GENESIS OF EPILEPSY.— Dr. Robinovitch.
marked pathological alterations; it is logical, therefore, that it
should lead us from the complex to the simple ; from the whole of
the disease to its primary element.
When the microscope shall have found the successive pathologi-
cal stages which characterize epilepsy, from its early birth onward
— and when all the other researches shall have accomplished the
same results, and shall have shown us where the beginning of
epilepsy is — that the slight vertigo of the alcoholic is a frequent
forerunner of epilepsy in his descendants, then will all the re-
searches end where we begin ; they will show that epilepsy has its
origin in parental alcoholism.
If, therefore, we are in a position to know how the primary
element of epilepsy may be eradicated, science is in a fair way to
know how to stop the progress and growth of that disease.
(To be continued.)
NOTE ON A PHENOMENON OF IMMEDIATE
FORESIGHT.
BY KAMA FAIRBANKS.*
Cases on paramnesia, illusions of false recognition and other
analogous phenomena are not rare now; I should have hesitated
to publish the case below were it one like those above, as it appears
to be at first sight. As will be seen, however, it is quite different,
the facts of the illusion being not recognized but foreseen; for this
reason I use the above heading to the case.
At about the end of October, 1900, I was attending a lecture in
psychology at the Faculty of Sciences of Geneva. It was my first
visit to the lecture room and it was also the first time that I saw
and heard the lecturer, Professor M. F. I was tired physically,
but my mind was perfectly clear and alert, as is generally the case
with me when I am tired. (I have even suffered a good deal from
insomnia through this.)
M. F. spoke of generalities and I marked down in my note book
everything that seemed to me interesting or important. At a cer-
tain moment he spoke of personal equation of astronomers, and I
marked this down also; the expression pleased me and I even
thought that it was a fine expression by which to designate the
differences of the ways of being or the character of people in daily
life. Then M. F. went up to the black board and illustrated his
arguments by drawings and figures.
At that moment, all of a sudden, it seemed to me that I was
miles away from the place of action, that I could hear the lecturer
with difficulty at that great distance and that / knew beforehand
what he was going to say. I had a very strong impulse to loudly
cry out every word before he uttered it ; and curiously enough, he
did speak the words I whispered to him mentally. The same was
true of the figures, which did not constitute mathematical relations,
but were simply figures chosen haphazard as examples. At that
moment, neither the lecture room nor the audience existed to me.
All I was conscious of was the presence of M. F. and myself in the
distance and I whispered to him beforehand word for word what
* Archives de Psycholagie de la Suisse Romande, 1901.
36 IMMEDIATE FORESIGHT.— Fairbanks.
he was saying, although the subject on which he spoke was for-
eign to me. Then I became much worried about this occurrence
which I could not explain to myself: I feared that the manifesta-
tion might be a symptom of some disease or insanity ; I feared par-
ticularly that I would faint and that I should thus cause a dis-
turbance in the lecture room, or interrupt the lesson, etc. I there-
fore tried with all my will power to come to myself again and into
the real world ; this I soon succeeded in doing. I do not think that
I missed one phrase spoken by M. F., although I was too perturbed
during this spell to take notice of what he was saying. As soon
as I came to myself I picked up the trend of my notes in which
very little of the lecture is missing and I calculate that the spell
must have lasted not longer than one minute.
This was not followed by anything serious, as I feared it would,
and the spell has not been repeated up to this date (July, 1900).
Wishing to explain to myself this phenomenon I tried to dis-
cover whether analogous cases had been published. Reading Dr.
Bernard Leroy's thesis on Illusions of False Recognition* I discov-
ered that I had often had, especially when a child, phenomena of
paramnesia or impressions of the already seen or already lived,
that is to say, a sensation similar to the one which Dickens men-
tions, as quoted by Bernard Leroy. Tolstoi has described this well
in Voina i Mir.
I was about fifteen years old when I first read the latter work
and I found that many sensations described there were analogous
to my own, which I had regarded as being normal. As an example
I might cite the following: I learned to read when I was three
years old and the Russian letter Y evoked in me the representation
of my nurse; whenever I looked at that letter I saw my nurse.
These things seemed to me to be perfectly natural and common,
and I attached no importance to them. It is only now, when the
incident that forms the subject matter of this paper has taken
place, that my attention is drawn to what happened years ago.
I have also had paramnesia in my dreams, by reason of their
repetition, as in the case of Natasha described by Tolstoi. ,
When I was about thirty, I sustained a severe nervous shock
that caused an intense moral emotion for some two years; this
was followed by an attack of neurasthenia that lasted two years
and a half. During that time I experienced at intervals the fol-
lowing impressions : I imagined that I was witness to an exhibi-
tion or performance, involuntary on my part, of my own acts,
movements and thoughts ; it seemed as if they came from some
* These de Med. de Paris, 1898.
IMMEDIATE FORESIGHT.— Fairbanks. 37
other person, that I was a spectator apart, in no relation with the
rest of the world; all objects had lost their natural aspect, every-
thing looked strange and astonishing. Often, I imagined myself
witnessing a dream or living through the scenes which I had read
in a novel long ago, the personages and objects seeming to be far
in the distance. When anyone spoke to me at such times I had
great difficulty, even when trying with all my power, to awaken to
the reality of things. I felt as if I were about to faint.
At times this double existence was even more marked; it was_
accompanied by a condition of profound apathy and it seemed to
me that nothing could astonish me, that I could never again have
the sensations of either joy or pain and that if a great misfortune
should befall me I would feel it not as an interested person but as a
reasoning witness.
During my illness I also suffered from fear of noises, which
caused me convulsive tics. I trembled at sudden noises.
At the time of the occurrence of the immediate foresight I was
in better condition than I had been during the previous two years
and a half. Besides, I was never ill before this illness, excepting
with the infantile diseases and two attacks of diphtheria.
What can be the origin of the phenomenon I have described?
The external conditions under which it took place are well defined.
The lecture room where M. F. gave the lesson was over-crowded
to suffocation. It was about after the first half hour of the lesson
that the incident took place.
But it is more difficult to explain the form of the illusion to
which I was subject. I insist on the fact that the illusion was not a
false memory or a false recognition. False memory approaches in
some respects the feeling that I experienced, excepting that the
feeling was the major element of the phenomenon and was not
accompanied by paramnesia : I knew what M. F. was going to say,
but not as if I recalled the words, for I felt all the while that the
subject he was discussing was foreign to me.
This is to say that the various theories put forward to explain
the illusion of the already seen cannot serve to explain what was
happening in my case. MM. Lapie1 and Bozzano,2 for instance,
believe that paramnesia is the result of dream combinations
brought into effect. This hypothesis explains well the case cited
by Bozzano himself or that of M. Hannais3, but it cannot be
1 Rev. philos. XXXVIL, 1894, quoted by B. LEROY, op. cit., p. 77.
2 BOZZANO, La paramnesie et les reves premonitoires, Revue des
etudes psychiques, 1901, p. 57 and 109.
8 Cited in The Unknown, by FLAMMARION, p. 530.
38 IMMEDIATE FORESIGHT.— Fairbanks.
applied to my case, which is rather one of promnesia than param-
nesia. The hypotheses by Wigam and Anjel cannot be applied
here, either. That of Lalande, who makes telepathy an interven-
ing element, cannot be accepted, unless all other means failed to
serve the purpose. The other theories explain the phenomenon of
recognition which characterizes paramnesia ; but I shall not exam-
ine those here, for what is distinctive of my case is precisely the
absence of recognition.
One might build the following hypothesis : I was a victim of
illusions which made me think that I foresaw M. F.'s words,
whereas in reality it was only the general meaning of the lesson
which pervaded my mind that brought about what I have stated ;
that I made, myself, an induction of what the professor was about
to say and thus imagined that I knew beforehand what he would
say. I do not think, however, that this was the case, for I always
think in the Russian language as well as take down lectures in it.
The words pronounced by M. F. in French could not, therefore,
have appeared to me to be a repetition of my mental language,
formulated in Russian.
It may be supposed also that by reason of fatigue or poisoning
by the vitiated air of which I have spoken, a condition of automa-
tism of the cerebral centres was brought about for a few seconds ;
that the words spoken were tardy in reaching my consciousness in
the form of words heard, and that, on the other hand, they excited
my centre of verbal articulation, so that I was pronouncing M. F.'s
words at the time when I heard them, or just before. It is known,
indeed, that functional cortical disturbances favor the occurrence
of automatism. This mechanism, if other facts permitted its veri-
fication, would explain, it seems, the illusion of immediate fore-
sight
The Journal of Mental Pathology.
Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. II. FEBRUARY, 1902. No. 1.
STATE PUBLISHING COMPANY, Publishers,
290 Broadway, NEW YORK.
MSS. and Communications should be addressed to the Editor, at
28 West 126th Street, New York.
Address bulky mail matter to P. 0. Box 1023, New York.
This Journal is published monthly, except in August and September.
Price of subscription, $2.50 per annum. Single copies, 50 cents.
Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope. News items from Institutions will be given all space
available.
SCIENCE VS. SECRECY.
While the promulgation of scientific information is the main
aim of this Journal, and while it is the intention of the editors to
limit the reading matter, so far as is possible, to scientific informa-
tion, it appears necessary to make some comment on the adminis-
tration of governmental functions, in so far as they relate to the
institutions for the insane.
The crying evil of the day so far as those institutions are con-
cerned, is the almost impenetrable barricade which rears its frown-
ing head at the entrance doors of every institution for the insane,
hiding its faults and defects behind the veil of sentimentality,
obscuring the perspective after the manner of the cuttle fish. By
an expert manipulation, the unsatisfactory condition of the vari-
ous public institutions has been placed in a dignified position of
security, by drawing the curtain of mystery over the life within
the walls of the institutions. Hypocritically raising its hands in
horror at the mere mention of publicity, the cult of secret ad-
ministration has managed to carry on its existence by dint of con-
stant iteration of the shibboleth : — "sacredness of the individual."
The hospital for the insane has not followed the progressive
example of the general hospital. It is only a short while since
sickness of every kind was adjudged a disgrace, and sometimes a
40 EDTTORTAL.
crime. With civilization and the spread of knowledge, more
humane treatment and consideration of the sick came into vogue,
and the hospitals were thrown open to students and to scientists
alike, and incidently became open to the public gaze. Those who
benefit by the present administration of the institutions for the
insane, however, have thus far managed to keep them in that
mediaeval stage of obscurity which so ill comports with the
progressive and common-sense ideas of to-day. The scientist in
search of material for earnest work is met at the portals of the
asylums with an emphatic negative. The forbidding frown of the
administrative bodies warns off the student who would fain enter
the house of the afflicted for the purpose of earnest study and
investigation. No helping hand is stretched out to welcome the
scientist who would devote his time to the study and perhaps
amelioration of the condition of the unfortunates housed within
the walls of the institutions. Under one pretext or another — by
playing the variations — as has before been said, on the sorry tune
of "privacy," "sacredness of personal rights," and all the other dis-
credited and antiquated apologies of the crafty, the sympathy of
the public is gained and perverted, to its own injury and loss.
It must be understood once and for all time that the opening
of the institutions for the insane to the visits of students and
scholars would not be a violation of personal privileges. The
student and the scientist are not curiosity seekers, who come to
watch the antics of the demented. These scholars are men and
women who are moved by a noble impulse to devote themselves to
a hard and thankless task. To place obstacles in their way is an
indignity, and no amount of specious pleading can change this
fact. Believing in these principles, it will become the province
of this Journal to carefully and considerately examine the work-
ings of every system of administration in the field of the institu-
tions for the insane, and to give them that consideration which
they deserve. Plainly speaking, we believe the time has arrived
when greed and ignorance should cease enjoying that unmolested
sway in the administration of the public institutions for the treat-
ment of the psychopathically afflicted which has hitherto been
almost a prerogative with them.
Need argument be adduced to prove the invaluable moral sup-
port that the student and physician brings to his patient by an
occasional visit from without, be that visit ever so short in dura-
tion? Need one remind those who would keep the asylum closed
to the outside student in psychiatry that the brightest hours of
the insane are those spent in conversation with the physician who
is an "outsider," with that physician whose daily contact with
COMMUNICATION. 41
the world keeps him in a more responsive mood to the patient's
recitals of his delusional sufferings?
We read with admiration the narratives of the devotion dis-
played by the noted psychiaters the world over, of the personal
attentions to patients, such as Falret, Esquirol and others displayed
in their wards, but some of our own authorities, whose presumable
duty as public servants is that of encouraging the workers in
psychiatry to follow in the footsteps of our celebrated masters,
lead one to infer that they consider themselves quit of all duty
after the dead psychiaters' deeds have been brought to mind and
properly admired.
The doors of the institutions for the insane should be thrown
open to students and scientists. It may not be possible for us
to see the arrival of the day when this condition will be an ac-
complished fact, but we trust to do some small service that will
help to accomplish this end at some time in the future.
We intend to do what little we can to force open to science the
hitherto sealed doors of the institutions for the insane.
We publish in this issue under the title "Heredity and Poetic
Talent" an abstract of a scientific research on the denomination of
the heredity of poets. The investigation has been made by a well
known German author, Dr. Mobius, and we are justified in accept-
ing his conclusions as being final. According to this author,
every man of vast intellect and poetic prodigality owed his natural
gifts to his mother — never to his father. Silly women never give
birth to sons of intellect.
Strengthened by this biological truth, the girl who wishes she
"were a man" should resort to the prerogative of her sex and
"change her mind."
COMMUNICATION.
DR. SELDEN H. TALCOTT, of the Middletown State
Homeopathic Hospital, N. Y., writes :
My Dear Doctor — In the November number of the Journal
of Mental Pathology you refer, very kindly, to our administer-
ing bed-treatment for the violent insane. This mode of treatment
has been in practice in this hospital continuously since February,
1879, a period of more than twenty-two years. I take pleasure
in sending you a copy of our sixteenth annual report, and on
pages nineteen and twenty you will find a brief account of "Hos-
pital Treatment for the Insane/' Bed-treatment for mental in-
valids has been extolled in several other annual reports of this
institution.
42 STUDY OF APHASIA.
EXTRACT FROM THE REPORT :
For several years we have adopted the plan of placing our patients in
bed for treatment, and sometimes this treatment has been continued, in
individual cases, for several months in succession. Of course we should
exercise a reasonable discrimination as to the classes of patients which
should be selected for the purpose of bed treatment. We have been most
successful in thus treating cases of acute mania, of acute melancholia, of
primary dementia, and of affording relief to general paretics, and to all
patients suffering with physical exhaustion, and tendencies to heart failure.
It is surprising to observe the quieting effects which follow this method
of treatment in cases of acute mania. By placing such patients in bed, in
suitable hospital rooms, by watching the patient carefully night and day,
and by encouraging them to rest (just as we encourage a typhoid fever
patient to remain quiet), and by furnishing an abundance of suitable food,
to supply with needed nutriment the worn, exhausted and irritated tissue of
the body, we have in a short time a quiet and self-controlled patient. These
same cases of acute mania, if allowed to be up and dressed, and moving
about in the wards, will continue for weeks and months in a state of elabo-
rate and unrestrained excitement. They remain devoid of self-control and
constantly exercising, regardless of the need for rest, until, worn and
wasted, they pass with remarkable directness into the sad and hopeless
realm of dementia.
Having tried the plan of allowing acute mania cases to take all the
exercise they could, and having been somewhat discouraged by the results
of such treatment, we passed gradually to the plan of treating such patients
with rest and an abundance of liquid food, and with steadily-increasing
good results. We feel now a reasonable satisfaction and confidence in this
method, and shall, therefore, continue it until we can find a better.
Through the erection of new day-rooms, we have been enabled to
enlarge and improve our hospital accommodations by using the dormitories
and day-rooms in part for these purposes.
Another advantage of hospital treatment is that we have been enabled to
do away with the muff, the body strap, and all coercive measures of an
unpleasant nature. Occasionally the padded mitten, or the protection sheet,
or the body bandage may be wisely and beneficially applied. But even these
are rarely necessary when our patients can be under the watchful eyes and
gentle hands of trained and competent nurses both night and day. (This
report was written in 1886.)
STUDY OF THE APHASIA PERSISTING DURING
CONVALESCENCE AFTER EVACUATION OF BRAIN
ABSCESS. — Dr. G. I. Walton makes the psychological report of
Dr. Jack's case of a brain abscess due to suppurative middle ear
disease. The patient was a newspaper reporter, 25 years of age;
the left ear had troubled him for three years. There was a dis-
charge last winter which ceased up to six months ago, when it
reappeared. During the last six weeks he suffered with frontal
headache, but there was no pain in the ear until two days before
admission to the Infirmary, when he awoke from a sound sleep
with a severe headache.
STUDY OF APHASIA. 43
Examination showed a small amount of pus in the auditory
canal. The walls of the canal were slightly swollen, but not espe-
cially tender to pressure. Landmarks of the drum membrane
were obscured by swelling. The posterior segment of the drum
was red and bulging. The mastoid was tender to touch over the
tip and antrum, but not swollen.
Severe headache appeared in a few days. The mastoid tender-
ness, however, gradually disappeared as did that of the canal. The
temperature fell from 101 F. (Aug. i) and remained at 99
degrees F. for several days. Paracenthesis of the drum was prac-
ticed and seven days later (Aug. 7), the patient had a chill and
complained of intense frontal headache. The temperature quickly
rose to 102 degrees F. There was no tenderness over the mastoid,
but an operation was deemed necessary. An extradural operation
was resorted to. The antrum was found filled with pus and soft-
ened bone with granulations and purulent matter were found. A
generous cleansing of the middle fossa was made and the lateral
sinus was also exposed about one inch in length.
The dura was normal in color and did not bulge ; the middle ear
was carefully curetted, removing the incus together with the
masses of cholesteatoma.
For a few days after the operation the patient's symptoms im-
proved. He then complained of severe frontal headache. On
August 16, eight days after the operation, the patient was found
in a comatose condition, pulling at the bed clothes. The tempera-
ture rose to 102 degrees F. and convulsions soon appeared in the
hands and arms. Four hours later an intradural section was made
over the squamous bone, upwards and for about 2 inches towards
the occipital protuberance. The dura bulged out and on making
the incision, over 4 ounces of pus were removed. During the few
days following the operation the patient seemed to improve, but
on August 18, his stupor seemed to increase, the discharge of pus
also lessened in amount and on August 22, the patient was quite
stupid, the temperature having risen. When aroused from his
stupor, the patient appeared aphasic: when shown an object, he
could not name it, although he could repeat its name when pro-
nounced before him.
More perfect drainage was resorted to, and the patient improved
rapidly with the free discharge of pus, making a perfect recovery
towards September 12.
The principal details of the form of aphasia in this case are the
following, as found on August 29 and 30 :
The patient is right handed and there was no paralysis or dis-
turbances of touch.
44 study of aphasia.
Activity of Auditory Word Centre and Glosso Kines-
thetic Centre With Afferent, Commissural and Emissive
Fibres. — The patient has moderate deafness, but not sufficient to
materially impair his ability to hear ordinary conversation. He
understands simple speech, but the understanding of speech of
higher order is somewhat impaired; he does not appreciate, for
example, the meaning of the word "explosion. " When asked to
make an exact copy of the numerals "5 plus 5 equal 10," he writes
"five plus five," failing to appreciate the meaning of the words
"exact copy." Spontaneous speech is somewhat impaired, wrong
words being substituted, such as arm, for ear. At times, meaning-
less words are used, — fels, for wings. "I don't know why I should
be theying on that;" apparently meaning, "I don't know why I
should fail on that" (alluding to his attempt to describe the man-
ner in which a bird flies). In naming the months of the year,
several are omitted at the first trial, although subsequently they
are perfectly named. When repeating sentences uttered before
him he substitutes a word for those spoken, like plight for flight,
or say for slay. He can carry a simple air, together with the
words, after being started, but cannot start it himself.
Activity of the Visual Word Centre and Cheiro-Kines-
thetic Centre With Their Afferent, Commissural and
Emissive Fibres. — Flis sight is good. There is no homonymous
hemianopsia. He recognizes simple printed or written words, but
does not recognize moderately difficult ones. He can read his own
writing 15 minutes after it has been written, also simple words
without the aid of tracing them over (Kinesthesis). He recog-
nizes objects; can write spontaneously, with freedom, but substi-
tutes incorrect words and meaningless words with about the same
frequency that he substitutes them in speaking. For instance, he
writes "let in the bed very comfontable," "glass of egg," for egg
on toast and spells steak stake; for thermometer he writes brothan.
In writing the months of the year he leaves out less than he does
in naming them ; half an hour later, when asked to name and write
the months again, he does both accurately and with equal facility.
He copies both written and printed words with an occasional mis-
use of a letter. He can copy numerals easily.
The Associated Activity of Three Centres, With Com-
missures Between the Auditory and Visual Word Centres
or Other Sets of Afferent and Emissive Fibres. — Reads sim-
ple sentences aloud, but fails to read more difficult ones, some-
times interpolating wrong words, at times uttering mere jargon.
Can name at sight a pencil or watch, but fails to name a thermome-
ter (a few days previously could name none of these objects),
STUDY OF APHASIA. 45
When the name of the thermometer is called out he can point cor-
rectly at the object.
In writing to dictation, athe eagle's flight is out of sight," he
first spelled eagle wrong; on the second attempt he spells eagle
correctly but writes, "The eagle's fly is out of sight," insisting that
fly is correct, even after his attention is called to it.
Lichtheim's test was applied, with the result that the patient
was unable to state, or to indicate by pressing the hand or other-
wise, the number of syllables, for example, in the words thermome-
ter, magazine and explosion, either on seeing them in print or
hearing them spoken.
The case bears marked resemblance to that of Marie and Sain-
ton, in which the autopsy bore out the diagnosis. The lesion in
this case was doubtless, mainly, if not solely, limited to the tem-
poral region.
This form of aphasia partakes of the character of Bastian's
amnesia verbalis, resulting from lowered activity of the auditory
word centre, as well as that of his commissural amnesia resulting
from defective transmission of stimuli to and from that centre. It
includes Wernicke's conduction aphasia, which denotes a break in
the connection between the auditory and the kinesthetic centres,
and is itself included in the comprehensive sensory aphasia of
Oppenheim and others and the auditory sensory aphasia of Collins.
That the auditory word centre was not entirely destroyed was
shown by the fact that the patient understood ordinary command ;
that its function was impaired was shown by his inability to under-
stand unusual words and sentences, as "state fair," "explosion;"
also by his inability to reproduce spontaneously in conversation
the desired word except of the simplest variety.
It is possible, in fact probable, that the auditory word centre
itself was not involved in the encephalitis, but the moderate word
deafness was due to impaired conduction of the afferent fibres con-
veying stimuli to that centre (subcortical sensory aphasia, pure
sensory aphasia of Dejerine). The result of such lesions is obvi-
ously identical so far as understanding the speech of others is con-
cerned. The diagnostic feature consists in the fact that if the
afferent fibres only are affected, the patient can still speak spon-
taneously, because the centres and connecting fibres necessary for
this function are intact. It might be inferred, then, that in this
case the auditory centre was affected because the patient could not
use spontaneous speech perfectly, but here we are met by the prob-
ability that the fibres connecting the temporal lobe with Broca's
convolution were interrupted, a lesion in itself sufficient to prevent
spontaneous speech.
4^ STUDY OF APHASIA.
Leaving out the difficulty in differentiating many important
points, this study shows that we may differentiate the sensory from
the motor forms of aphasia with some accuracy.
It seems probable that the fibres connecting the visual with the
auditory centre were interrupted, for the patient found difficulty
in reading aloud, and although he could recognize an object he
could not recall its name. The fibres passing in the opposite direc-
tion were doubtless also interrupted, for he could not write diffi-
cult words from dictation. That the fibres passing from the audi-
tory area to Broca's convolution were probably impaired is shown
by the fact that although he could hear and, to a certain extent,
interpret from hearing, he could not talk correctly (paraphasia).
To what extent these different structures were invaded it is im-
possible to determine. Probably the visual word centre was spared
and the patient's inability to recognize certain words when he saw
them was due to the inability to reproduce the sound of the word
through its sight, that is, interruption of the fibres connecting the
visual with the auditory word centre.
This case tends to corroborate the views originally held by Broca
and Trousseau and later sustained by Wernicke, Dejerine, Collins
and many others, that there is no writing centre in the sense of a
centre in which are stored up the kinesthetic memories of written
words, and capable of stimulation independent of Broca's convolu-
tion. The inability to write in this case was absolutely coincident
with the patient's inability to talk. The words he could utter he
could place upon paper; those which he could not — he utterly
failed to write. When the auditory centre either failed to recall
the memory of the sound of the word, or if remembered, to convey
the stimulous properly to the kinesthetic speech centre, it failed also
to communicate it to the centre for the movements of the hand. It
is true that at the first trial he wrote the names of the months better
than he pronounced them, but in order to do this he took time, and
repeatedly scanned his list. The fact that half an hour later he
was able also to say them, showed that there was really little to
choose between the two defects. To one sustaining the views of
Bastian, that the centre for hand movements is capable of being
stimulated from the visual and auditory centres independently of
Broca's convolution, it might be claimed that this case merely
showed that the fibres to both the hand centre and to Broca's con-
volution were equally impaired. In view of the prevalence of
similar cases, and of the dearth of definite cases of agraphia with-
out aphasia, the prevailing opinion seems opposed to Bastian's
theory. [In a recent article on "Cerebral Anesthesia," contributed
to "Brain," the writer reports a case which might be cited as an
MENTAL STRUCTURE OF HALLUCINATIONS. 47
illustration of agraphia without aphasia. The patient, who suf-
fered from a local cortical lesion accompanied by attacks of Jack-
sonian epilepsy, always commencing in the hand, had no defect of
speech, but could only write by tracing the letters slowly as if
learning them anew, although she had perfect control of the move-
ments of the fingers. She had, however, equal difficulty in sewing,
or performing any movements requiring the appreciation of the
feeling of objects in the hands, nor could she name such objects
with the eyes closed (astereognosis). The inability to write did
not demonstrate, then, lesion of a special centre for writing, but
was only a single sign of the loss of the kinesthetic hand memories
(active touch) resulting from lesion of the psychological group of
fibres and cells presiding over the stereognostic sense. The prob-
able seat of the stereognostic sense for the hand is not far distant
from that assigned by Bastian to the centre for writing memories,
and it requires no great stretch of imagination to assume that the
one includes the other.]
That the centres and fibres affected were not destroyed is shown
by the complete recovery. The patient was examined two months
later and no defect of speech could be elicited by the most search-
ing examination. He performed his duties as a newspaper re-
porter as usual ; he said, however, that on one occasion he found
difficulty in spelling the words jewel and yet. It is reasonable to
suppose that words like those, which are less readily acquired than
others, are also less readily retained. {The Boston Med. and Sur.
J our., Dec. 26, 1901.)
CONTRIBUTION TO THE STUDY OF THE MENTAL
STRUCTURE OF HALLUCINATIONS— DRS. VASCHIDE
AND VURPAS arrived at the following conclusions from their
study of the genesis of hallucinations in a hysterical subject dur-
ing the wakeful and the hypnotic states :
A sensory spell, or, in other words, a mental spell, can co-
exist with a very restrained field of consciousness.
A hallucination may take place during a condition of complete
sensory anaesthesia, involving various categories of images and
at times the entire mental activity. This fact is of importance
and may serve to elucidate the question of the genesis and the
nature of hallucinations.
It seems that hallucinations may exist more or less independ-
ently of sensory excitations.
Hallucinations may exist while the sensory field is in a condition
of absolute distraction ; they set in during the beginning of or the
48 MENTAL DISTURBANCE.
awaking from hypnotic sleep as well as during the waking state.
Certain hallucinations are due to sensory disturbances. Some
artificial modifications enabled us to induce visual hallucinations
in our patent.
It seems reasonable to distinguish two kinds of hallucinations ;
the first, due to functional disturbances or some sensory illusions,
the others — to permanent central excitations (Arch, di Psi., Sc.
Pen. ed An. Crim., Vol. XXII, F. IV- V.
A CASE OF riENTAL AND NERVOUS DISTURB-
ANCES DUE TO HEPATIC INTOXICATION. —DR. G.
CATOLA reports an interesting case of marked mental and nerv-
ous disturbances which seemed to be due to no other cause than
that of defective hepatic function : the post-mortem examination
revealed extensive and marked impairment of the structure of the
entire cerebrum; this accounted for the profound psychic as well
as paralytic disturbances manifested during life; on examination
of the viscera, all the organs, save the liver, were perfectly normal.
The liver, however, was the seat of marked organic disintegration,
every element having undergone a pathological change. The
author concludes that the cerebral changes and the consequent
psychic manifestations were the results of hepatic intoxication.
He calls to mind the fact that Pinel and Esquirol believed that
hepatic disturbances could produce hypochondria by reflex action ;
that other psychiaters also insisted on the presence of hepatic dis-
turbances in cases of melancholia. (Rivista di Patologia Nervosa
e Mentale, Nov., 1901.)
K ANATOMII EPILEPTICHESKAVO SOSTOJANIA
(ON THE QUESTION OF THE EPILEPTIC STATE)
DR. KOTSOVSKI makes a review of the extensive literature on
this subject, and cites two cases of epilepsy with an autopsy in each
case. Both cases died in status epilepticus. Commenting on the
causes and pathology of epilepsy, the author concludes by saying
that the various forms of the malady may be brought under the
heading thus tabulated : Toxic epilepsy is a general disease ; an epi-
leptic condition is the result of a marked infection. Epilepsy of
cortical origin may be functional or anatomical ; status epilepticus
is the result of local cerebral processes. This is given, of course,
as a schematic table. The main point desirable to bring to light is
the fact that many cases of epileptic condition have an anatomical
basis which explains sufficiently the morbid appearance. (Journal
S. S. Korsakova, No. 4, 1901.)
CEREBRAL ABSCESS AND EPILEPSY. 49
CEREBRAL ABSCESS FOLLOWING CHRONIC OTOR-
RHEA, EPILEPSY OF 14 YEARS' STANDING. TRE-
PHINING FOLLOWED BY RECOVERY DR. GORIS
reports this case. The patient is 23 years of age; he has been
subject to epileptic attacks since he was nine years of age — ac-
cording to information given by the mother — and to chronic
otorrhea since he was 13 years of age. On June 22, the patient
suffered intense headache and an examination of the seat of
trouble made it apparent that an operation was necessary at once ;
trephining of the mastoid process was resorted to and a large
cholesteatoma was removed, a temporary amelioration of the
patient's condition following. On July 30, there was an acute
exacerbation of meningeal nature, intense headache and vomiting
dominating the scene ; a severe epileptic attack took place, but the
seizure had none of the characteristics of a Jacksonian epilepsy.
The incision was made on a vertical line passing through the axis
of the auditory canal and on a plane directly above the roof of that
canal. The dura mater bulged out as soon as the incision was
made; a large cerebral abscess was found, holding 25 cc. of pus.
The patient remained in a condition of torpor during the two
days following the operation but his mind remained clear. From
the day of the operation to the time when this report is made,
three months after the operation, the patient has been entirely free
from the usual epileptic attacks. The author concludes that it is
reasonable to suppose that the epileptic attacks set in after the
chronic otorrhea took place. {Jour, de Chir. et Ann. de la Soc.
Balge de Chir., Nov.-Dec, 1901.)
ANOMALIES DU POLYGONE ARTERIEL DE WILLIS
CHEZ LES CRIfllNELS EN RAPPORT AUX ALTERA-
TIONS DU CERVEAU ET DU COEUR Dr. CH. PARNI-
SETTI made a study of anomalies of the circle of Willis in the
brains of various criminals, homicides, assassins, thieves, highway
robbers and others. He tabulates the results of his investigations
and the following are the conclusions :
In the criminals, the circle of Willis presented anomalies of
origin, development and course in 65.51 per cent, of the cases
examined. On the left side, these anomalies were observed in
32.18 per cent, of the cases.
The cerebral tissue is influenced by these vascular defects and
a decreased nutrition results therefrom ; this may be accompanied
by inferior organization of the nervous centres and consequent
phenomena of arrest of development and manifestation of de-
generacy.
50 THE INEBRIATES ACT.
The criminals' brains were found to be deficient in weight in
73.56 per cent. ; in 51.72 per cent, of the latter there were anomalies
of the circle of Willis, as well as anatomo-pathological changes of
the meninges, the cerebral substance and the blood vessels; there
was also anaemia or hyperaemia of the meninges, ventricular effu-
sion, atheromatous foci, softening, etc.
The cardiac development seems to be intimately connected with
that of the circle of Willis.
In 75.86 per cent., the weight of the heart was below par and
49.42 per cent, of the above corresponded to the anomalies of the
circle of Willis ; the grosser organic lesions of the cardio- vascular
system, such as cardiac atrophy, vascular insufficiency and left ven-
tricular hyperaemia, ran hand in hand with the other anomalies
enumerated above. (Fifth International Congress of Criminal
Anthropology, Amsterdam, 1901.)
THE WORKING OF THE INEBRIATES ACT.— DR.
CARSWELL, in a paper bearing this title, states that it is desirable
to have this act changed so that the medical authorities of insti-
tutions for inebriates should have the power of detaining the sub-
jects for an indefinite period of time, according to individual re-
quirements; better results might thus be obtained than are now
possible when the subjects are returned to their vicious life and
surroundings as soon as the urgent signs of the intoxication are
abated. (The Journal of Mental Science, October, 1901.)
PHTHISIS AND INSANITY.— DR. TH. DRAPES made
an elaborate study of this subject and concludes that if phthisis is
found to cause death in a large number of cases in asylums, the rea-
son is a simple one: the breeding of this disease is encouraged by
unhygienic ways, such as draperies, carpets and other articles used
for furnishing the asylum rooms. He suggests that bare floors and
the absence of curtains would be preferable in asylums. An elab-
orate table shows how much greater the mortality from phthisis is
in the insane than in the sane, at given periods of life. ( The Jour-
nal of Mental Science, October, 1901.)
ON THE FAVORABLE RESULTS OF TRANSFER-
ENCE OF INSANE PATIENTS FROM ONE ASY-
LUM TO ANOTHER. — DR. A. R. URQUHART states that
from his experience patients benefit greatly by being transferred
from one asylum to another at judicious intervals of time. In
chronic cases this method is particularly to be utilised. From a
statistical study of a number of cases during a period of 20 years
CEREBRAL LOCALIZATION OF MELANCHOLIA. 5*
the doctor concludes that one can justifiably claim n per cent, of
recoveries as due directly to this method.
We attach much value to the improvement obtained in 5 per
cent, of the cases treated with a thyroid gland extract, and yet we
pay little attention to a larger per centage of improvements ob-
tained by transferring patients from one institution to another.
{Journal of Mental Science, October, 1901.)
THE CEREBRAL LOCALIZATION OF HELANCHOLIA —
DR. BERNARD HOLLANDER cites numerous cases in
support of the idea that there is some relation between lesions
of the angular and supra-marginal gyri and the manifestation
of melancholia. He concludes that :
I. — All the evidence produced in the paper points to the fact
that there is a certain relation between the central area of the pa-
rietal lobe, namely the angular and supra-marginal gyri, and the
melancholic state of mind.
This is demonstrated by over fifty cases of injury to the parie-
tal tuberosity or its neighborhood, which were severe enough to
affect the brain or its membranes, and from the fact that half of
these cases recovered under surgical operations.
It is demonstrated by the mental symptoms accompanying tu-
mors growing in, and limited to, this area.
It is demonstrated by the effects of inflammatory disease limit-
ed to this region.
It is demonstrated by the idiopathic haemorrhage sometimes oc-
curring under the parietal protuberance (subsequently forming
false membranes or cysts) after sudden fright, severe mental
shock, or other depressing emotional disturbances, or in mental
disease ushered in by an attack of melancholia.
It is demonstrated that the symptomatical atrophy, frequently
observed as taking place in the parietal protuberance, is due to
a trophic change accompanying a melancholic state of the patient.
Cranial disease affecting this brain area, and congenital abnor-
mal development thereof, may also originate melancholia.
II. — It is argued that simple melancholia has as its basis a mor-
bid condition of the emotion of fear. This emotion, though all-
pervading, must take its start in a limited portion of the brain,
which area, when fear is manifested morbidly, as in the different
degrees of melancholia, must betoken lesion. Experimental and
anatomical evidence is adduced showing that :
(a) The physical expression of fear and its related states can
be produced in animals by the excitation of the central parietal
area.
52 PHYSICAL AND MORAL INSENSIBILITY.
(b) That this same area has a close connection with the sym-
pathetic nervous system and the vaso-motor nerves, which are both
affected in melancholia.
(c) That in lesions of this area rise of blood pressure, altera-
tions of sensibility, disturbances of vision, and cortical blindness
may accompany the melancholic state. {The Journal of Mental
Science, July, 1901.)
PHYSICAL AND flORAL INSENSIBILITY IN THE
CRIillNAL. — DR. W. N. EAST summarizes his researches thus :
The normal individual has more acute moral and physical sensi-
bility than the criminal.
Considered as classes, the accidental, occasional and profes-
sional criminal represent three degrees of moral insensibility.
The difference between the moral insensibility of the accidental
and occasional is greater than that between the occasional and pro-
fessional.
The difference between the insensibility of the accidental and oc-
casional is less than that between the occasional and professional.
The influence of education on moral or physical insensibility
appears to be unimportant.
Those who commit crime against the person, commonly passion-
crimes, have least moral and physical insensibility.
Those who commit crimes against distant property, commonly
intellect crimes, have more moral and physical insensibility.
Those who commit crimes against near property, and sexual
crimes, have still more moral and physical insensibility.
Sensations are impaired in the criminal — that is, the number of
conscious elements are less than in the normal human adult; the
number of perceptions possible to the criminal are less, and so
the ideas of the criminal mind are less than in the mind of the nor-
mal human adult. A mind lacking in ideas is a mind presenting
some enf eeblement ; the evidence of this enfeeblement is most
commonly expressed in the criminal by deficient moral sensibil-
ity. {Journal of Mental Science, October, 1901.)
DISTURBANCES OF SPEECH IN MALARIA.— DR. TIKANADZE
reports three cases of disturbance of speech which seemed to have been
due to malarial infection. He concludes in the Bol. Gaz. Bot., Nos. 13, 14,
1901, that:
The speech disturbances observed during the course of malaria are
essentially of the form of ataxic aphasia.
Simple embarrassment of speech and stuttering are comparatively rare.
These disturbances are found preferably in the pernicious forms of
malaria; the trouble takes place generally at the onset of or during an
attack, but rarely after it.
PSYCHIC TREATMENT. 53
Malarial aphasia is more frequent in man than it is in woman.
It is often accompanied by paralysis, is transitory in nature, of short
duration and the prognosis is favorable. (La Med. Marital, December,
1901.)
HEREDITY AND POETIC TALENT.— Report of M. MOBIUS'S
WORK.— M. CHASLIN made the report to the Medico-psychological
Society of Paris. — The poetic talent is congenital; education has never
created a poet. How does heredity manifest itself? In mathematicians,
mechanicians, musicians and sculptors, the heredity is generally homologous
and almost always on the paternal side. This is rare in poets. In the
history of poets one seldom finds the same name repeated; when this is
the case the bearers of the names are brothers.
The great poets, as Goethe, Schiller, Burger and Byron, are solitaires in
their families. If their fathers or sons were poets, we are unaware of the
fact. One must search in the mother for the germ of the poetic talent. The
intellectual faculties of the mother are of paramount consequence to the
poet. This is true also when the poet is a woman. The author cites cases
showing that both mother and daughter were equally gifted and renowned
in this direction; this fact never happens where other artistic talents are
concerned.
This truth would tend to bring the poet nearer the superior intelli-
gence than the artist. Men of vast intelligence are always sons of capable
women. Silly women have silly sons. (Annales Medico-psychol., No. 3,
1901).
PSYCHIC TREATMENT.— DR. E. C. BUNGE, Superintendent of
the St. Louis Insane Asylum, writes an interesting paper under the above
title. With the experience of an interested psychiater, he pleads in earnest
terms for the adoption of a simple method of treatment for the insane;
that method consists of individual demonstration of interest in every case
separately. While the method he recommends is simple, its performance
is not easy; it requires an untiring perseverance on the part of the physician
and a sincere devotion to the patient that can be demonstrated by those
only who appreciate the dignity of the duty they are called on to perform.
The psychic treatment consists of the demonstration of personal interest in
the patient's amusements, works, talks, walks, entertainments, etc. The
inmates must be treated as nearly like sane people as the circumstances
permit, making the sufferers feel that they are not cut off from the world
entirely. Visits from outsiders, ex-patients and other sympathetic persons
are encouraged to the great advantage of the patient. Excursions to the-
atres, concerts, promenade trips outside the asylum walls and occasional
visits to the people at home by the patients have given gratifying results.
The author advocates the idea that patients be given a certain monetary
remuneration for the work they perform in the asylums. Such a method of
treating patients' labor would tend to instill interest in the tasks and would
make the work a useful psycho-therapeutic agent. (American Journal of
Insanity, October, 1901).
THE TREATMENT OF DEAFNESS BY SONOROUS VIBRA-
TIONS.— M. MARAGE publishes a communication relative to the treat-
ment of deafness ; the exact acuteness of hearing in determined and a vibra-
tory massage is practiced by transmitting to the ear the fundamental
vibrations of the vowels ; the vibrations are produced by a siren e, through
54 ABNORMAL BRAIN DEVELOPMENT.
the intermediary of a membrane that neither adds nor suppresses any har-
monics. The author has obtained good results in 37 cases of deafness that
followed catarrhal otitis, otorrhea or sclerous otitis; in four cases there
existed, in addition to the organic trouble, nervous deafness, Meniere's
vertigo, and dumbness. This treatment is free from harmful results; it
diminishes the dizziness from the start and seems even to arrest the progress
of sclerous otitis. {Progres Med., December 7, 1901.)
ABNORMAL BRAIN DEVELOPMENT.— DR. H. C. EYMAN de-
velops the theme implied in this title with arguments free from anatomical
demonstrations. He calls attention to a couple of families whose generic
development is instructive to the student of psychiatry. The heads of the
respective families are Margaret Jukes and Jonathan Edwards. Margaret
Jukes embraced a life of profligacy and her descendants, within the course
of one hundred and seventy years, had cost the communities in which they
lived $1,250,000 as criminals and paupers. Three hundred and ten of the
descendants had spent their days as public charges ; one hundred and fifty
were victims of loathsome diseases, sixty were professional thieves, and
fifty women had led degraded lives. Only twenty of those descendants had
learned trades; ten of these had acquired the knowledge of handicraft in
prisons. The record of the good citizen, Jonathan Edwards's descendants,
is an extreme opposite in quality to the one above cited. The family
counted two hundred and eighty-five college graduates, of whom sixty-five
became professors in colleges and thirteen became college presidents; there
were, besides, more than one hundred lawyers and thirty judges in that
family. The author lays much stress on the influence of environment,
although he admits that the latter is not an infallible remedy in all cases.
{American Journal of Insanity, October, 1901.)
IS LEGAL RECOGNITION OF GRADUATED RESPONSIBILITY
PRACTICABLE?— DR. A. B. RICHARDSON is of the opinion that the
cases of defective morality committing major crimes should be examined
more closely for legal purposes than they are to-day, and that they should
be punished with the view of securing to society safety from their repeated
criminal acts. He cites an example of a morally defective subject who
attempted homicide on a woman who refused to accept him in conjugal
ties; the attempt was made with a pen knife and in a manner indicative
that the would-be assassin was an imbecile. The author thinks that in a
case like this the judge should not be lenient in the meting out of punish-
ment; on the contrary, such an individual should be isolated from society
indefinitely, as the low mental and moral standard which prompted him to
commit a first crime will certainly actuate him in the same direction on
future occasions. The nature of the institution in which such subjects
should be confined can easily be decided according to the individual offend-
ers. {American Journal of Insanity, October, 1901).
BOOK REVIEWS.
LE CRIME DAN5 LA FAMILLE.— PAR LOUIS AL-
BANEL, Docteur en Droit, Juge d'Instruction au Tribunal de la
Seine. J. Rueif, Paris. Considering the contents of the volume,
one feels tempted to repeat part of the stanza by Victor Hugo
BOOK REVIEWS, 55
(from "Les enfants pauvres") with which the preface of this work
opens :
Prenez garde a ce petit etre,
II est bien grand, il contient Dieu.
The subject matter of this work is criminality, and as may be
inferred from the quotation — essentially juvenile criminality.
Although the subject is handled with the philosophic seriousness
that the question requires, one cannot mistake that the supreme
note here is that of humaneness. The author asks: Why does
crime exist ? What are its causes ? Can they be eradicated ? What
are the remedies?
In the first chapters the parents — their individual, social and
sociological conditions are analyzed ; the children are studied next
from the same standpoints. Parental correction and correctional
education are treated of next and the work is concluded by in-
structive chapters on the preservation of normal childhood through
Governmental intervention, and the reforms required to attain the
desired end.
Six hundred families who have passed through the judge's
hands are analyzed individually in the relations mentioned above
and although the study is technical to a marked degree, the color-
ing of the life of those subjects is so vivid that the reader feels as
if the life of Gavroche were being depicted many times over. The
narrative of the life of these juveniles in the model reformatory at
Mettray — their industry, application and transformation towards
the better, supplies a goodly amount of material for thought anent
the present state of sociology.
A society (Patronage Familial) was founded in 1900 with the
view of extending all available assistance to needy children.
VORLESUNGEN UBER PSYCHOPATHOLOGIE IN IHRER
BEDEUTUNG FUR DIE NORMALE PSYCHOLOGIE MIT
EINSCHLUSS DER PSYCHOLOGISHEN GRUNDLAGEN
DER ERKENTNISTHEORIE — GUSTAV STORRING, Dr.
Phil, et Med., Privadozent der Philosophic an der XJni-
versitat, Leipzig. Mit Figuren im Text. Verlag von Wil-
helm Engelmann, Leipzig, 1900. — The psychopathic manifesta-
tions are considered in their relation to normal psychology. The
question of whether the physical condition has an intimate influ-
ence on the mental manifestations or whether, on the contrary, the
mental condition brings about certain physiological states of the
organs, is considered at length. Lange asks : When I am threat-
ened with danger, at a pistol's point, and I shudder with fright,
my heart beating fast, — is it the mental state that brings about my
56 BOOK REVIEWS.
physical condition, or is it that the physical condition precedes the
mental state, or, — is there any relation between the two manifesta-
tions at all ? There are certain substances which act on the organ-
ism in such a manner that the psychic and accompanying physical
effects are quite analogous yet individually independent. Alco-
hol, for instance, in its initial stage of action, causes men-
tal exhilaration and an accompanying increase of the cardiac
beats, a dilated vaso-motor condition, a heightened cerebral
blood supply, etc. In this case, the fact is certainly evident
that there is no absolute necessity for the joint influence of
mind on body, or vice versa, as the vaso-motor condition
here is not dependent on the mental influence. Similar instances
can be observed in the effects produced by opium, hashish, mor-
phine, ipecacuanha, the bromides, etc. Lange holds that mental
manifestations are intimately related to physical conditions, but
this is a question that can be contradicted by many facts, although
some cases with disturbances of general sensibility prove the truth
of this supposition. Delusions, hallucinations, illusions and delu-
sional interpretations are considered in their relation to normal
psychology, and numerous classical cases are cited and analysed
in the same relation. The book is replete with interesting studies.
It has 468 pages.
DIE BEHANDLUNG IDIOTISCHER UND iriBECILLER
KINDER IN ARZTLICHER UND PEDAGOQISCHER BEZ-
IEHUNG. —VON WILHELM WEYGANDT, Dr. Phil et Med.,
Privatdozent an der Univ. Wurzburg, Specialarzt fur Nerven-
krankheiten and Psychiatrie. Mit 2 Abbildungen. A Str liber's
Verlag. Wurzburg. The author considers the classification of
idiocy and imbecility, passes in review the defects of the special
senses which so often accompany the two diseases, and devotes
special attention to the consideration of the psycho-pedagogic
treatment of these subjects. The author's familiarity with the in-
stitutions and methods for this kind of patients adds much value
to his effort. The volume consists of 103 pages.
BOOKS AND PAMPHLETS RECEIVED.
LA PSYCHOLOGIE ETHNIQUE. CH. LETOURNEAU, Secretaire
general de la societe d' anthropologic, Professeur a Vecole d'anthropologie.
Schleicher freres, Paris, 1901.
SOUKHANOFF. LA THEORIE DES NEURONES EN RAPPORT
AVEC QUELQUES ETATS PSYCHIQUES NORMAUX ET PATHO-
LOGIQUES.
SOUKHANOFF. L'ANATOMIE PATHOLOGIQUE DE LA CELL-
ULE NERVEUSE EN RAPPORT AVEC L'ATROPHIE VARI-
QUEUSE DES DENDRITES DE L'ECORCE CEREBRALE.
SOUKHANOFF. CONTRIBUTION A L'ETUDE DES MODIFI-
CATIONS QUE SUBISSENT LES PROLONGEMENTS DENDRITI-
QUES DES CELLULES NERVEUSES SOUS L'INFLUENCE DES
NARCOTIQUES.
MARIANI. UNA SANTA DELERIO EROTICO=RELIGIOSO.
I CRIMINALI RUSSI E LA TEORIA DI C. LOM-
BROSO.
NAECKE. QUELLE EST LA MEILLEURE MANIERE DE PLA-
CER LES CRIMINELS ALIENES?
P. SERIEUX. LA DEMENCE PRECOCE.
SERIEUX ET FARNARIER. TRAVAIL ET ALITEMENT DANS
LE TARITEMENT DES MALADIES MENTALES.
F. X. DERCUM. A CLINICAL CLASSIFICATION OF INSANITY.
G H. HUGHES. MEDICAL ASPECT OF THE CZOLGOSZ CASE.
SANO. LA COLLOCATION DES ALIENES INDIGENTS A
SCHAERBEEK.
SANO. LA LOI SUR LE REGIME DES ALIENES.
FEN ALGEMEEN PLAN VAN HET ZENUWSTELSEL.
OVER KRANKZINNIGEN-VERPLEGING IN GROOTE
STEDEN.
f Vol. II.
\X\^\x\vx\^yt
No. 2.
The Journal of
Mental Pathology
Subscription Price J — $2.50 per annum*
Single Copies, 50 cents*
Edited by Louise G. Robinovitch, B. ts L., M.D.
Kditorlal Board
Dr. V. MAGNAN, Dr. A. JOFFROY Dr. F. RAYMOND (Paris), Dr. CHAS. K. MILLS (Phila.),
Dr. JUL. MOREL (Belgium), Dr. E. REGIS (Bordeaux), Dr. G. CESARE FERRARI, Editor Rivista
Sperim. di Fren. (Italy).
BAILEY, Dr. P. (New York) ;
ILLON, Dr. Edgar (Paris);
NEVILLE, Dr., Chief Physi-
bumania) ; BRIAND, Physician
(Paris); CHATTERJI, Mr. J. C.
ychologie (Switzerland) ; CROCQ,
LL. D., Jurist Ministry of Justice
Co
ALBANEL, L., LL. D., President
BAJENOW, Dr., (Moscow); BEC
BLEULER, Prof. E. (Zurich); BLI
cian Bicetre Asylum, Editor Progrks M,
to the Asylums of the Seine; BALLET,
(Bernares, India); CLAPAREDE, Dr.
Prof., Editor Journal de Neurolgie (Belgium
(Russia) , DEKTEREW, Dr. W. de, Member Municipal and General Council (Russia) ; DAGONET, Dr. ;
FAURE, Dr. Maurice; FERRI, E., LL. D., Deputy (Rome, Italy); FAREZ, Dr. Paul; GREIDENBERG,
Dr. B. S. (Russia) ; GARNIER, Dr. P., Expert at the Tribunal (Paris) ; JANET, Dr. (Paris) ; KOPOS-
SOW, Dr., Superintendent Simbirsk Asylum; LALANNE, Dr.; LANGELAAN, Dr. J. W. (Holland);
LEGRAS, Dr.; LEGRAIN, Dr.; LOURIE, Ossip, Ph. D. (Paris); MARRO, Prof., Dir. "Annali di
Freniatria" (Italy); MARIE, Dr. Auguste, Chief Physician Villejuif Asylum; MARINESCO, Prof. G.
(Roumania): MARTIN, Dr. E. (France); MEDICI, Dr.; MacDONALD, Dr. A. E., Superintendent
Manhattan State Hospital (New York); NAMMACK, Dr. Ch.; NEISSER, Dr. CLEMENS, Chief
Physician of the County Asylum, Leubus (Germany); OBICI, Dr. (Italy); PETERSON, Dr. F., Com-
missioner in Lunacy, State of New York; FIERON, Dr. H., Preparateur Laboratory Experim. Psych.,
School of Higher Studies (Villejuif); PHILIPPE, Dr. CI.; REGNARD, A., Ministry of the Int.,
(Paris); REIS, Dr. Mello (Brazil); ROBERTSON, Dr. F. W., General Superintendent Elmira Reform-
atory; REY, Dr. Philippe, Superintendent Public Asylums (Aix) ; RITTI, Dr. Ant., Chief Physician
Charenton Asylum; SEMELAIGNE, Dr. Rene; SEMIDALOW, Dr. B. (Russia); SERIEUX, Dr. P.
(France); SERGI, Prof. G. (Italy); SINANI, Dr. B. N. (Russia); SERBSKI, Dr. V. P. (Moscow);
SNELL, Dr.; SOUKHANOFF, S., PrKat. Docent, Univ. Moscow; SPITZKA, E. A. (New York);
STOENESCU, Dr. N. (Roumania); TATY, Dr. (France); TSCHISCH, W., Prof. (Russia); TREVES,
Dr. Marco (Italy); TOULOUSE, Dr. E., Chief Physician Villejuif Asylum, Director Laboratory Exper.
Psych., School of Higher Studies; TRUELLE, Dr.; VAN DEVENTER, Dr., Dir. Meerenberg Asylum,
Holland; VAN HAMEL, G. A., Prof. Criminal Law, Univ. Amsterdam; VURPAS, Dr. CI., Asylums of
the Seine; VAN GIESON, Dr. Ira T.; VALLON, Dr. Physician to Ste. Anne, Expert at the Supreme
Courts (Paris); VASCHIDE, Dr. N., Chef des Travaux, Laboratory Exp. Psychol. (Paris); VOISIN,
Dr. Jules, Physician to the Salpetriere (Paris) ; WINKLER, Dr. C.Univ. Amsterdam.
STATE PUBLISHING COMPANY
290 Broadway, NEW YORK, N. Y.
TABLE OF CONTENTS
LEADING ARTICLES.
On the Mental Analysis, Vaschide and Vurpas 57
Political Assassins; Are They All Insane? Dr. E. C. Spitzka 69
The Genesis of Epilepsy Clinically Considered. The Pathology, Pro-
phylaxis and Treatment of Epilepsy, Dr. Robinovitch 83
The Transformation of Crime and the Modern Civilization, Alfredo
Nicefero 88
EDITORIAL.
The Evolution of Crime 91
TRANSLATIONS AND ABSTRACTS OF CURRENT LITERATURE.
A Contribution to the Study of Stereotypias 93
On the Significance of Individual Statistics in the Question of Heredity
in Neuro and Psychopathology 94
A Case of Cerebral Tumor of Psycho-paralytic Form, 95
Cerebral Syphilis Stimulating General Paralysis 97
A Case of Epilepsy Following Traumatic Lesion of Prefrontal Lobe.. 99
Two Cases of Lipoma of the Brain 100
Note on the Prefrontal Lobes and the Localization of Mental Function 100
Degeneration of the Optic Thalami 101
Case of Unilateral Hallucinations of Hearing, Chiefly Musical ; with
Remarks on the Formation of Psycho-Cerebral Images 102
Tumor of Posterior Central Convolution 103
Parasite of Epilepsy 104
On the Mental Development of a Cretinoid Child Under Thyroid
Treatment 104
Treatment of Acromegaly with Pituitary Bodies 104
Insanity and Poisons 105
On the Determining Causes of the Formation of the Visual Organs. . . . 105
Hydrocephalus and Small-Pox 105
Professional Toxic Polyneuritis 105
Spells of Anxiety, Epilepsy and Hysteria 106
The Sensations of an Electrocuted Professor 106
Hysterical Crural Monoplegia 106
A Case of Cerebellar Concussion 107
A Study of the Hereditary Effects of Alcohol 108
Simple Hypertrophy of the Brain 108
The Phenomenon of Inhibition : 108
Case of Epileptic Convulsions Caused by a Shoe Button in the Nose. . 108
Case of Instrumental Amusia in Progressive Paralysis 109
BOOK REVIEWS.
Die Beziehungen des Nervensystems zu den Thraenenorganen, zur
Bindehaut und zur Hornhaut. Ein Handbuch fuer Nerven und
Augenarzte, von Dr. H. Wilbrand, Augenarzt, und Dr. A. Saenger,
Nervenarzt, in Hamburg. Mit 49 Textabbildungen, 2d Vol. of "Neu-
rologie des Auges." /. B. Bergmann, 1901, Wiesbaden no
La Psychologie Ethnique. Par Ch. Letourneau. Schleicher Freres. . in
Cos'e il Genio? By Adolf e Padovan. Ulrico Hoepli, Milano 112
Prize for Original Research in Medicine 112
Books and Pamphlets Received 3d cover
The Journal of Mental Pathology.
Vol. II. MARCH, 1902. No. 2.
ON THE MENTAL ANALYSIS.
BY N. VASCHIDE, Chef des Travaux, Laboratory Exp. Psychol., School
of Higher Studies,
and
CI. VURPAS, Physician. Asylums of the Seine.
We have elsewhere ( i ) attempted to describe the role of mental
analysis as applied to certain psychopathic disturbances. When
applied by the subject to himself, this analysis led up systemat-
ically to a variety of morbid disturbances described under the
name of delirium of introspection, somatic or mental; when ap-
plied by the subject to his surroundings, the delirium of introspec-
tion is engrossed by one of metaphysical nature. In those studies
we analyzed the mechanism of the psychic disturbances; we
brought to light the mode of formation of the delirii and their
mechanism. This particular side of the question, although most im-
portant in the matter of the understanding of the morbid psychic
construction, is, nevertheless, insufficient as an explanation of all
the conditions of the phenomenon; for, we thus study the mech-
anism of the pathological construction only, leaving out the deep
causes, the knowledge of which could aid in determining the criter-
ion, by which one could differentiate a delirious construction from
that of a genius or of other high standard. In our former studies
we have described the conditions which surrounded the develop-
ment of the delirious disturbances, but we have not insisted suffi-
ciently on the conditions under which all the morbid psychologi-
cal constructions developed and evoluted. The few considera-
tions on this question are disseminated here and there, but they
are not united and synthetised so as to bring them to light as their
importance deserves ; these considerations elucidate the genesis and
the conditions of psychological development and construction of
the system in the delirium. In the present study we endeavor to
bring those points to light and to make clear their pathological
significance.
II. We wish to remark first of all that the construction of a
delirium requires more than a simple exaggerated mental analysis
jg MENTAL ANALYSIS.— Vaschide and Vurpas.
pushed to excess. It seems that conceptions of import differ
from trivial ones in the degree of mental analysis and the sagacity
that the author or subject exhibits; the mental analysis is, there-
fore, the condition of progress in the intellectual domain, but not
the cause of more or less profound psychopathic disturbance. In
this condition there is an element of primordial importance which
distinguishes the conception of high order from that of delusional
nature; and if the exterior aspect of the mental analysis seems to
enter into play in both instances, there is, nevertheless, a capital
difference between the psychological conditions under which the
development of the mental construction is brought into effect —
the psychic orientation is totally different in the two instances. This
difference of mental orientation in both cases constitutes, to our
thinking, the true distinction between the two conditions so differ-
ent from each other.
We do not need to cite individual cases here in order to illustrate
our arguments ; the cases to which we shall refer are frequent in
occurrence and well familiar to the student of psychiatry ; he can
recall from his own experience the necessary examples to which
we shall here allude.
III. Let us study the mental status which accompanies the on-
set and the evolution of the various delirii. We exclude here
purposely the psychopathic disturbances dependent on gross ana-
tomical or congenital lesions as found, for instance, in the general
paralytic, the various dements, those with circumscribed lesions,
the idiots or the imbeciles. With the exclusion of these few morbid
categories, the other various psychic disturbances seem to us to be
under the dependence of the same psychological process, which is
a mental distraction and disorientation.
It is important to define well what we understand under the term
distraction. In a work on The Psychological Disturbances Con-
sequent on Artificial Hallucinations we said that: (2) "During
the so-called normal state, the mental condition of G., one of our
subjects, presents pretty nearly the same degree of attention found
in the normal subject. But an intense mental image, an ideation
which exteriorizes itself, destroys the power of attention, the moral
synthesis being directed instantly toward that image and adapt-
ing itself intimately to it. This imposed image occupies the con-
sciousness and brings about a state of distraction when the hal-
lucination is of an average intensity. When the hallucination is
very intense, however, the state of distraction is replaced by a true
condition of mental confusion. This experiment, enabling us to
make such a near approach of those two psychic states, seems to
shed some light on the mechanism and the mental structure which
MENTAL ANALYSIS.—Vaschide and Vurpas. 59
govern the state of confusion. The induced ideation is rapidly
adopted, and as the distraction grows in intensity the subject ends
by believing in the reality of the image. In the course of a hal-
lucination, the image imposes, so to speak, through ideation that
it evokes, either an arrest of thought, — an arrest of the faculty of
recollection, and with the increased intensity of the hallucination,
the distraction leads to the evolution of a state of confusion ; this
state is nothing else than the highest expression of a hallucination,
a state in which the images rapidly succeed one another, fluttering
about the object of the evoked hallucination. The co-existence of
the images becomes more and more blunted, whereas the psychic
erethism increases progressively.
What characterizes, in the first place, the mental condition of the
delirious subject is a state of distraction in which he is plunged and
which is most apparent. It seems that the external world has not
the usual effect on him. Events and persons make less intense
impressions on him and the effects differ from those in the nor-
mal state. The subject is more indifferent to the events of life
which concern him and he is more credulous than usual, avoiding
less the numerous difficulties of life. This distraction may spring
from several mechanisms. In certain instances it depends on
more or less definite psycho-physical causes, as seen, for instance,
in cases of poisoning by various agents — Hashish or Morphine, or
in the various forms of toxi-infections ; these conditions may be
compared to those observed during sleep. Outside of the yet un-
determined psychophysiological causes of sleep, if one studies the
psychological conditions under which it takes place, it is seen that
it consists of a condition of profound distraction, particularly of a
sensory distraction, as well as in a distraction of judgment, com-
parison and guidance. It seems that a distraction of the same
kind is found in the conditions of the various toxi-infections,
which, without being quite as pronounced in degree, appear to be
of the same psychological stamp.
There are, besides these toxi-inf ectious conditions, other psycho-
logical states which may end in similar results; these states are
those which are consecutive to various mental disturbances. On
the occasion of some powerful emotion, whatever the cause may
be (external and dependent on social surroundings, or subjective
and causing a psychic concussion), this emotion which astonishes
or shocks the subject brings about by its intensity and the place
which it occupies in the field of consciousness a true mental dis-
orientation as well as a polarization of the mind on a special and
well defined point. There one sees that now the coefficient of
emotion is so intense that the subject remains astonished and in a
60 MENTAL ANALYSIS.— Vaschide and Vurpas.
condition of mental disorientaion and distraction which has struck
him ; this coefficient or mental emotion becomes so intense that it
subjugates the representative coefficient of his mental images, so
that he feels himself to be the plaything of the high coefficient of
emotion of his intellectual states; now the subject simply loses all
his points of habitual control and guidance, and every mental
image that presents itself to his mind, of a whatever sufficient de-
gree of intensity, becomes a pivot or a theme about which he builds
and constructs more or less intense and durable delirious concep-
tions. The last mental image will be replaced by a new one every
time that its intensity is higher than that of its predecessor and
will be sufficiently marked to break the commenced psychic linking.
At times, the subject, finding himself in a disordered mental
state, tries, like one bewildered by the tumultuous flow of thoughts
which disturbs his consciousness, to reassure himself, and he then
directs his investigations either on himself or on the external sur-
roundings, in order to find there the cause of his mental distress.
As there is polarization of his mentality, the subject is in-
capable of control and of verification and cannot direct logically
his investigations in the field which he has chosen or rather which
has presented itself to him. All his investigations are directed
hap-hazard at first, and on finding a certain path of reasoning
he follows it with a perserverance which heightens sometimes his
delirium so that it even becomes well systematized ; but he is led
up to this by accident, without comparison or verification, without
any analysis of relation of facts, following out his ideas as such,
not heeding the necessity for correcting their meaning by outside
elements ; he keeps on, without paying any attention to aught else
than the more or less hypothetical conception to which he subju-
gates all other facts, these being considered as quite useless.
The subject is thus naturally led to making a psychological con-
struction without any value or import ; and although one finds in
that reasoning a certain system, even well co-ordinate, indicating
the path that the subject has chosen for directing his activity in
the attempt to explain his position to himself, it is seen that the
enterprise fails by reason of psychic disorientation caused by the
polarization of his mental state, thrust into a given direction.
We have seen in what has been said that the most important
part of this mental state was the distraction which could install
itself in various ways in the minds of various subjects. This dis-
traction was compared, in a general way, to the state of sleep. It
can also be compared to hallucinations.
In another contribution we have shown that hallucinations de-
pended on a condition of a particular distraction, causing a sort of
MENTAL ANALYSIS.— Vaschide and Vurpas. fo
discontinuation in the life of the subject. The conditions accom-
panying the development of sleep represent admirably the psycho-
logical conditions favorable to the development of hallucinations.
We know how frequent their occurrence is in that condition. The
toxi-infectious disturbances reproduce very well the psycho-bio-
logical conditions of sleep; it is not astonishing, then, to find so
frequently the occurrence of hallucinations in these psycho-physi-
ological disturbances.
As for the delirii of more or less direct psychological causation,
the conditions under which these mormid disturbances develop ex-
plain sufficiently the raison d'etre and the conditions governing
the production of the hallucinations so often observed in these
psycho-pathic disturbances ; the conclusions are in accord with the
results of our previous works, in which we studied the genesis
and the conditions of the production of hallucinations. We
found that they depended on a condition of distraction of the
mind — a veritable discontinuation in the mental life.
The condition of psychological disorientation, — distraction,
which governs the evolution and the construction of the various
delirii, as we shall see presently, explains perfectly well the fre-
quent existence of hallucinations in all mental disturbances, as
their cause and their conditions of psychological production are
the same and spring from the same state.
These observations are in perfect accord with those noted so
often by eminent and enlightened clinicians, to wit — that halluci-
nations did not precede the delirium, but were, on the contrary,
consecutive to it, or, at the very least, evoluted with it; in any
case, they are not the basis, cause, or fundamental point of de-
lirium, as certain authors had supposed. The first manner of
looking at this subject seems to us the true one : First, there is a
condition of distraction and mental disorientation, — a condition
of psychological disarray. These conditions are eminently
propitious for the development of a delirium and of hallucina-
tions. We make it a point, however, that the delirium is the first
to make its appearance, the hallucinations following after it ; and,
although consecutive in order, they help the development of the
delirium by circumscribing it the more definitely; although both
are evoluting by reason of the same mental condition and under
the same psychological status, one helps the other mutually,
strengthening the subject's psychopathic conceptions.
IV. Generally speaking, mental activity is considered from a
narrow point of view. The ancient conceptions of the correla-
tion of mind and body have left their indelible traces in science
and especially in medicine. The old epithets are simply re-
52 MENTAL ANALYSIS. — Vaschide and Vurpas.
placed by modern terminology, the essential teaching remaining
intact, indisputable. To be more explicit, it was taught that the
intellect or soul acted independently of any physical evolution of
the body. There was, in a word, a simple parallelism, prear-
ranged according to certain laws. The various philosophical
postulates which expressed them have been the subject of long
discussions in times past; those discussions spring up with our
modern doctrines, under different forms, but in the name of the
same search for the logical. By way of opposition to the flow of
the old doctrines, the domain and the influence of that mental life
has been so narrowly restricted that it is almost confounded with
some anatomical elements which the biological knowledge ex-
pounds and circumscribes more and more as constituting the
physical "I."
Without stopping to bring history into this sketch, we simply
state that to-day this mental activity is considered by a large num-
ber of authors as being a quantity which, if not nil, is, at any rate,
of little weight in the changes and the composition of our "I," — this
unstable contrivance of which we seize only the motive of the sym-
phony and the musical chords.
Anatomy attempts even to explain the genesis of mental activ-
ity. Supported by facts scientifically demonstrated, so-called,
it strives to give us the key to every one of the multiple aspects of
that proteic modality, — mental life.
Reaching out to the ingenious hypotheses of the admitted sys-
tems in the domain of biological science, physical or medical, it is
endeavored to explain psychic life on a physical basis exclusively
and categorically. These explanations are resorted to constantly,
even when the most complex phenomena are concerned. The
multiple mental combinations, as a function or a mechanism, are
put forth as understandable phenomena. Others, again, histo-
logical sections in hand, force their attempts of explanation so far
as to localize in a given point of the cortical surface the generating
apparatus of this or that element of our mental activity.
The anatomists, either those who, with a table knife, slice the
brain and study it microscopically, or the others, who analyze at-
tentively the intimate structure of the nervous system, as far as
the modern methods enable us to delve into the splendid micro-
scopic display, pile up for us a whole psychological system which
is presented to us under the title of psychological anatomy. We
neither wish to contradict nor to combat those doctrines which
must certainly contain some true elements in their essence; we
only think, with other psychologists, that since the time of the
genial conception of Fechner it has been attempted to explain the
MENTAL ANALYSIS.— Vaschide and Vurpas. 63
influence of the psychic over the physical by means of facts re-
lating to that domain; there is one fact, however, the relation of
which to the cerebral topography or physiology has not been
explained by any anatomical doctrine ; it is this fact which consti-
tutes the very essence of mental life, — it is the mental activity.
To our knowledge, no systematic study has been made on the
subject of the nature and the role which this activity plays in the
mental life and the organism. Attention has been attracted
to certain consequences of some orientation of this essentially
psychological element; it has been studied as a function of the
will-power, and has been garbed in certain psychological togas, —
attention, distraction, will power, scruples, but no study has been
directed outside of the path outlined for us by some philosophers.
In a series of previous contributions we have attempted to
study and to define, basing ourselves on the analysis of suggestive
pathological cases, the ensemble of psychological attitudes bent
on mental analysis. In this present study we wish to complete
and elucidate our thoughts by certain synthetic ideas which will
prove helpful in the understanding and the knowledge of the
role played by the mental analysis in our psychological architec-
ture.
In one case, the mental analysis was directed to the structure
itself of the mental life; the disturbance in question we called
delirium by mental introspection. Everything that passed be-
fore the subject's vigilant eye, all the phenomena of conscious-
ness that could be registered, even the most minimal and the most
intimate, everything was weighed and sifted through a sieve of
perservering logic ; a logic that was anxious, particularly scrupu-
lous and for this reason led up to the delirious form which we
have brought to light.
In the second case, the subject directed his mental analysis only
to the physical modifications of his organism and to the knowl-
edge of his somatic constitution which wholly occupied his psy-
chic activity. The mental analysis, or, in other words, the intro-
spection, studied in detail every sensory, organic or other pheno-
mena. Being in a condition that made it impossible for him to
direct and to group the results of his numerous and anxious
researches of introspective nature, the subject took the path
towards a delirium and soon exhibited a well defined delirium of
somatic introspection.
In a third case, the subject directed his mental analysis toward his
surroundings, elucidating his interior mental life by a few vague
glimmers of light, — he lived, consequently, in a delirium of ex-
trospection, the origin of which resided in this mental analysis
fa MENTAL ANALYSIS.— Vaschide and Vurpas.
which, in its turn, was directed by the changes and more or less
complicated aspects of his social life.
Finally, in a fourth case, the subject's ideas pivoted about the
microcosmic architecture of the world, the metaphysics of
nature.
We have described that case as one of metaphysical delirium.
The four aspects of mental orientation which we have described,
regardless of their pathological forms, represent, in our opinion,
grosso modo, all possible orientations of mental activity as such;
in other words, this covers the field in which mental analysis can
exercise its action and in which one can keep track of it. This
construction of the pathology of delirium helps understand, from
more than one point of view, the psychic act which we are consider-
ing here, — the pivot of mental life. It might be said that there is
a schematization, so to speak, of the various forms of normal anal-
ysis, touching with its activity on the multiple conditions of real
life, — normal life, so called.
The personal synthesis being destroyed, so to speak, because of
a pathological impression due to a delirious form of introspective,
extrospective or other nature, and also because of the absence of a
logical polarization of the images and the sensory or other impres-
sions, the majority of the normal and habitual psychological ele-
ments become effaced and completely disappear in the face of the
pathological disorder, which, in turn, plays a preponderating and
well defined role.
While analyzing all our observations and trying to compare them
to the manifestations in normal life, we came to the conclusions
above formulated, namely, that mental analysis can manifest itself
only from the four following starting points : I, the analysis of the
"mental analysis itself;" 2, the physical and somatic manifesta-
tions of the system ; 3, the social life and the surroundings, the race
and species ; 4, the metaphysical life conceived under its most ab-
stract form.
Without having anatomical proof in hand, we think that mental
analysis exists and constitutes the pivot, the most solid, perhaps, of
the mental activity in psychic reactions toward which converge and
from which sets out every impulse or action which shows even the
slightest trace of consciousness ; this analysis represents a unique,
real, and a posteriori, definite centre, — one that has the property
of polarization and of utilization of images formed by the senses.
This property puts that centre in a place by itself, its role ex-
tending to the very biological function of the system.
From the analysis of some score of normal cases belonging to
various social categories it is seen that the mental analysis exer-
MENTAL ANALYSIS.— Vaschide and Vurpas. 6$
cises mutual and simultaneous or successive actions on every one
of these fields of exploration and of orientation.
The biological life is thus subconsciously led on to its very
bloom. The synthesis of gradual development, the outcome of the
mental as well as of the physical evolution of the organism, tends
towards a stable equilibrium in relation to the four directions
above mentioned, and centers about the psychic orientation and the
mental analysis.
The healthy subject who lets himself be carried away by this
or that of the orientations, no matter how unsound in its logic,
never forgets his starting point, the origin of his orientation ; this
characteristic distinguishes him from the pathological being. He
is solidly guided by the pre-established equilibrium and he seldom
oversteps the extreme limits of orientation which he has chosen to
follow. On the contrary, instead of letting himself be led on
blindly by his sensations (as does the delirious subject), of which
he understands neither the function nor the structure, he readily
resigns himself and bows before the impossible elements as one
does before so many lost dreams. He thus places himself, by
reason of such a method of living, in a perfectly normal social and
cosmic condition, which maintain his perfect psycho-physical or-
ganization ; he accepts submissively some vague facts suggested by
intuition, interesting himself automatically, mostly, in the mediate
reaction of life. The surrounding atmosphere leads him gradually
to his biological end. This is accepted, although under some
protest, at a more or less advanced age. The function of the indi-
vidual organs, especially the one which constitutes the most per-
fect human machine, forces on him a statu quo which cuts short
all his flights and forces him to accustom himself to some more
or less vague and misty facts. The greater part of his mental life
thus dwindles away and with it go the details of his intellectual end.
end.
Man's life is reduced to the knowledge of some crude facts, the
points toward which the orientation of mental analysis is directed.
The same is true of the consciousness of the body, the social sphere
and the metaphysical preoccupations. Every new knowledge that
falls under the mental analysis exercises an influence according to
its intensity, the impulsive tendencies or, particularly, the richness
of its images and its affinity with the mental analysis of the subject ;
the latter, however, instead of losing himself in speculation, puts
a check in this functional direction. An element of importance in
this connection is the co-efficient of contentment that every step
of mental analysis suggests to the subject.
Even in the normal subject, the equilibrium is seldom absolute,
56 MENTAL ANALYSIS.— Vasch IDE and Vurpas.
the balance bending either towards one or the other side in the
sinuous evolution of life. Now a subject shows orientation either
in this or that direction of mental life, concentrating himself in it,
by accidental reason or by a systematic planning based on the
capricious images that crowd the mind. He may, on the other
hand, direct his analysis on the somatic configuration of his or-
ganism and the qualitative and quantitative co-efficient of his sen-
sory impressions, or else touch on his social surroundings ; finally,
he may become the plaything of his metaphysical research.
All this is performed, however, in relation to the rest of the
configuration of the I, being guided particularly by a linked series
of facts having a normal relation to the surroundings.
Mental analysis is only a guide towards one or the other orien-
tation; but its initial cause, which supposes the existence of an
affinity with the psycho-physical structure of an individual, may
be difficult to determine. This analysis is part of a whole series
of social or psychological causes which bring about a state of
forced activity in our being.
This mental analysis is the laboratory, so to speak, which elab-
orates the plates of our thoughts, judgments and emotions of every
act accompanied by any degree of consciousness.
Our psychological existence, then, is identical with mental anal-
ysis. The knowledge of ourselves, our biological existence and
our place in nature are but equivalents of mental analysis. The
intelligence alone does not suffice for the purpose of investigation
of orientation of mental life ; analysis represents the highest form
of mental life.
One could have, then, an index to a person's intellectual vigor
in psychic orientation from the knowledge of his psychological
spinning ; the latter is of capital importance ; we are ignorant not
only of its genesis, which would be excusable, but also of its
transformation and especially the complex aspects in the normal
morbid logic.
We have tried to sketch and to determine the structure and form
of mental analysis as well as its mechanism of psycho-physical pol-
arization under its crudest aspects. The normal man, although
less conscious of his mental analysis, in the philosophical
sense of the word, is in a state of conscious or sub-conscious
delirium which is enacted step by step, so to speak, ever retracing
his path, reaching back safely to the starting point ; the insane sub-
ject differs from the former in that he seems to hurl himself,
methodically or precipitately, towards a different orientation,
specializing himself according to the affinity and the psycho-
physiological disturbance engraved by his mental analysis. He
MENTAL ANALYSIS.— Vaschide and Vurpas. 67
voluntarily shuts himself in within himself ; but as his conceptions
are without any cohesion, he may thus end either in a condition of
ecstacy, similar to the mental inertia, or in a state characterized by
an ensemble of diverging judgments, the lack of understanding of
which leads him to precipitated states of anguish, anxiety, emotion
or tenderness.
He reminds one, to some extent, of the life of investigators,
thinkers, creators, literateurs, artists, etc., who, under the apparent
aspect of a real life feed and systematize some delirium of intros-
pection. The whole lies in the sense in which the mental analysis
has been directed.
We wish to remark that these psychic phenomena, by reason of
their intimate relation with our /, are very difficult to seize and it
is not without some difficulty that one contrives to single out their
external attitude. The mental analysis is, if we are allowed to
make this comparison, the dragon of the legends who zealously
guards the entrance to that saintly temple, — the mental life, the
only sanctuary in which we find living of interest, in which we
exhibit our desires and fears, in which we give free expansion to
our anxiety, or build chimeras, all, while living the common life
which requires especially a well systematized automatism directed
towards well defined aims. And yet we look askance when the
verbal manifestations or external attitudes of the insane are con-
sidered with some credulous faith, while that subject is adjudged
as such and his mental life is contested.
It may happen, as we have had occasion to notice in our obser-
vations, that the mental analysis has a most intense life. The
coloring of the expressions is then factitious, so to speak, and the
mental life, shut in within itself, under the shield of a pathological
mental analysis, may become the scource of a delirium.
It happens, finally, that in various cases the mental analysis is
broken by some pathological disturbances, the subject assuming
the same attitude before the images as that taken by the dreamer
facing multiple and incomprehensible scenes ; he can take no de-
cisive step, his mental condition resembling a stagnant water, the
subject being led either to a state of mental confusion, or to one of
mental inertia, — a state which requires careful study in connection
with the morbid disturbances of the will and attention.
In concluding, shall we make the ironical statement as below:
The mental analysis, a phenomenon synonymous to a large extent
with our conscious and logical I, while directing our psychological
and social conduct, is itself subjected to its proper criterion. In
that chaos called thought there are labyrinths in which more than
one sideway leads the traveler on the wrong road ; no matter how
68 MENTAL ANALYSIS.— Vaschide and Vurpas.
interesting the first few steps might be, one slips, without even
noticing, into a mental orientation which, no matter how directed,
is full of anxiety and disturbing emotions. One faces then prob-
lems that one does not dare attack and before which it is also
difficult to retreat; one ends, then, by staring at unintelligible
enigmas of life, which, if interpreted by our ignorance, become
still more false in nature ; on this road, the first collision encount-
ered may favor the display of disturbances of a pathological
nature.
At least, this problem, which slumbers in every mental analysis,
requires either the support given by some credulity which facilitates
greatly the road and its deviations by reason of some moral sup-
port, or, more frequently, some criterion, which is generally less
manageable; in either case, there is here a tottering equilibrium
which is disquieting from moment to moment.
Shall we remark that, outside of the scientifis side of our
researches, one should refrain from resorting to mental analysis
for fear that it might bring about serious psycho-pathological or
physical disturbances, as psychic conditions unquestionably influ-
ence the organism?
Are we to lend as little attention as possible to our mental life
and swathe our mental life by a principle of moral hygiene, trust-
ing ourselves as little as possible to the seductive psychological
raking ?
In order to be a happy mortal it seems that one has to content
one's self with the crudest possible facts of mental analysis and
hope that it suggests, just the same, a strong and healthy "excel-
sior."
REFERENCES.
i. I. N. VASCHIDE ET CL. VURPAS. Di alcune attitudini caratter-
istiche d'introspezione somatica patologica. Riv. Sper. di Fren., Vol.
XXVII., p. 179-186.
N. VASCHIDE ET CL. VURPAS. Delire par introspection mentaie.
Nouvelle Iconographie de la Salpetriere, May-June p. 238-251, 1901.
N. VASCHIDE ET CL. VURPAS. Delire par introspection. Cen-
tralblatt fur Nervenheilkunde und Psychiatrie, Vol. XXIV., July and Aug-
ust, 190 1.
N. VASCHIDE ET CL. VURPAS. Contribution a l'Etude de la
Structure Mentaie des Hallucinations, Archivio di Psich. Scien. Pen., etc.,
Vol XXIII., fasc. 4-5, 1901.
2. N. VASCHIDE ET CL. VURPAS. Recherches sur les troubles
psychologiques consecutifs a des hallucinations provoquees, Archives de
Neurologie, No. 69, 1901.
POLITICAL ASSASSINS; ARE THEY ALL-
INSANE ?
BY E. C. SPITZKA, M. D., OF NEW YORK.
I have elsewhere undertaken the criticism of an article ( i ) by the
distinguished alienist Regis of Bordeaux, in so far as it exempli-
fies what I venture to regard as the defective reasoning of the
advocates of "Degeneracy ;" taking that term in the all-compre-
hensive sense in which it is employed by their school. In this
place I shall endeavor to point out their debatable positions taken
in regard to the subject of "Regenticides" or political assassination,
exclusively considered.
The following definition of the Regicides is offered by Regis,
(p. 145, loc. cit.).
"Degenerates of a mystic temperament, who, misguided by a political
or religious delirium, complicated sometimes by hallucinations, think them-
selves called on to act the double role of judiciary and martyr; who, under
the influence of an obsession that is irresistible, kill some great personage,
in the name of God, the country, Liberty, or Anarchy."
A "mystic temperament" is not always an insane temperament ;
nor is the assassin commonly of the former mental complexion.
He may even be of a most practically materialistic bent; as were
most of the Nihilists ; as were Reinsdorf and his companions ; and
as was the last actor in our own series of tragedies. In some,
Luccheni for example, the assassin is too vulgar and of too coarse-
fibred an organization to justify a search in him for anything
"mystic;" unless it be through mystically befogged investigation;
undertaken by one, easily mystified, at that. Likewise does it fall
short of the first condition of a definition, of being uniformly true,
that assassins contemplate the combined role of murderer and
martyr. Scores like Orsini never dreamt of being discovered;
dozens like Fieschi, Booth and Hamilton had made elaborate prep-
arations for escape ; many like the latter and Maurevert did escape ;
and such as were captured later were so, because Poltrot-
like, they obeyed that strange fascination, perhaps mystic
(1) "A Protest Against the Degeneracy Chimera." Philadelphia Medical
Journal, February, 1902. In order to omit repetitions of what I have de-
tailed elsewhere, I refer the reader to that article for strictures on the
insufficient evidences statistically considered, brought to bear on the subject
by Regis, as well as the singular historical errors into which that writer had
fallen — probably through one or other of the hastily compiled compendia of
the dav.
70
POLITICAL ASSASSINS.— E. C. Spitzka.
in one sense, which draws ordinary criminals back to hover
around the scenes of their crimes. The definition would not even
fit the really insane regicide in all cases; the "order to General
Sherman" to "call out the troops" as a thoughtful provision
against mob violence (2) is a case in point.
Is Regis well assured that the regenticides captured and exe-
cuted had always anticipated that fate as certain? Do not the
facts show that the chances of escape are sufficiently great to
render a regicide's taking the chances merely a question of rela-
tive boldness as compared with other homicides? Let us see.
There have been committed in Europe in the nineteenth and
commencement of the twentieth centuries 152 attacks of this char-
acter. The following proved fatal, and to this day the successful
assassin remains unknown or escaped.
ANVITI, Minister to Ferdinand of Parma.
BALTSCHEFF, Roumanian Minister.
GUTSCHOFF, Russian Colonel of Gend'armes.
HAUSER, Caspar, royal waif.
KRAPOTKIN, Russian General in Gubernatorial position.
LESSING, labor agitator and suspected spy.
MESENZOW, like Krapotkin.
MINUTOLI, Cabinet Minister of a Thuringian State.
OBRENOVITCH, Sovereign of Servia.
PRIM, Spanish Premier, Regent pro tern.
PARMA, Ferdinand Charles II, Duke of
PRIMO-RIVERAS, Captain-General, Madrid.
QUESADA, Spanish political leader and general.
ROSSI, Count, Papal Premier, 1848.
RUMPFF, chief of Frankfurt police.
SELIVERSKOFF, Russian agent at Paris.
STRELNIKOW, like Krapotkin.
STAMBULOFF, Premier of Bulgaria.
To these are to be added one of the Phoenix Park murderers,
Tynan; also Hartmann and Chalturin, the contrivers of the
Livadia Railroad and the Winterpalace explosion attacks on a
Russian Czar. Although identified, it was after they had secured
their immunity through flight and lived under assumed names
after. There are in addition eleven assasinations of a total of
(2) The certain prospect of which would, I believe, act as a more effici-
ent deterrent than any, even the most cruel, doom of law, on both sane and
insane contemplators of regicide. The reference in the text is to the assas-
sin of Garfield.
POLITICAL ASSASSINS.— E. C. Spitzka. 71
twenty, all but one having been successful, of Presidents of
Spanish-American Republics.*
Of the following attempts made in Europe, those undertaking
them escaped identification, the attempts, however, having failed.
Amadeus of Spain.
Bratianu, Minister of Roumania.
Faure, French President (Bomb thrown June 13th, 1897),
George IV of England.
George, Grecian King.
Konstantin, Russian Archduke.
Labori, Dreyfus counsel.
Liiders, Governor of Poland.
Louis XVIII, twice; once as Comte de Provence, 1798, and
1820, as King of France.
Narvaez, Spanish Premier.
Thiotis, Greek Minister, 1901.
Wielopolski, Military Governor of Warsaw.
A total of 35 assaults occurred by unknown assassins, of which
21 proved fatal, 4 resulted in wounding, and 10 failed altogether.
If the American cases be included, the total rises to 47, with 34
fatalities out of 174 cases. In addition to those who had escaped
arrest and enjoyed immunity by remaining anonymous, others
have remained immune, even after arrest and trial ; Leonie Leon,
who slew Gambetta, the partly successful assassin of General
Lagarde and Vera Sassulitch, the all but murderess of General
Trepow, the chief of the "Third Division" and "Terror of the
*On excluding cases where a conspiracy was not matured, in other words,
the attempt was not actually realized, as well as those where the assassina-
tion took place under cover of a revolt, the percentage of fatally ending
attempts among Presidents of Spanish-American Republics is 78.9. This,
as well as the absolutely high number of these tragedies, will not surprise
those who read in the history of more than one state, "This was the first
President to complete his term of office, and leave it to his successor with-
out the accompaniment of a revolution, massacre or flight." The following
list I believe to be incomplete. Of the cases in the text one or two may
prove to be incorrectly enumerated, the assassin possibly having been iden-
tified unbeknown to me.
Arboleda
Comonfort
*Moraes
Balta
Dessalines
Morales
Barrundia
*Diaz
Pizarro (Vice-Roy)
Barrios Reina
Flores
Salnave
Blanco
Francia
**Santos
♦Bolivar
Gill
Uruquiza
Borda
Guardiola
*Campos-Salles
**Linares
♦Not injured.
**Wounded an
id survived; the remaining
sixteen perished.
?2
POLITICAL ASSASSINS.— E. C. Spitzka.
Nihilists," being examples. To these might be added at least one,
Dr. Bernard, of the Orsini assassins ; the Portuguese Mascarenhas
was merely banished; Ragosa was liberated by the verdict of an
Italian jury, while his accomplice was hanged, pursuant to that of
an Austrian one.
Thus a superficial search reveals no less than 53 instances in
which mostly one, in several presumably more than one assassin
escaped out of a total of 174 cases ; or excluding the assassins of
Spanish-American Presidents as disproportionately fortunate,
there remain 41 such cases, of a total of 152, a ratio of 26 9-10 per
cent.
Before pronouncing the regenticide as so much more a degen-
erate fool than is the ordinary murderer, would it not be well to
compare with these figures such representing the ratio of escapes
and immunity of the latter? As I have had occasion to say
elsewhere, in taking exception to reasoning which made degen-
eracy and lunacy prevalent among regenticides, resting that reason-
ing on the unprofitableness of their crime: "Every criminal is a
fool, but that does not make every or any criminal a lunatic any
more than that his insanity makes every lunatic a criminal." In a
full one-quarter of the cases one or other assassin remained
exempt from retributive death whether by law, by lynchers or by
his own hands.
We are told categorically : "As for the regicides themselves,
besides the numerous nervous and mental disorders to which they
are subject, they are also degenerates." The discrimination here
implied as between degeneracy and mental and nervous disorders,
is not clear. Lombroso for example throws them all into a com-
mon chaos. Aside therefrom, the statement is not borne out by
the cases cited. The hallucinations of Clement and Ravaillac I
have shown, elsewhere, to be of a class of phenomena, too common
in their day to predicate insanity on them alone; and as regards
the cited instance of Poltrot's praying and feeling strengthened
thereby (p. 142, loc. cit.), I have, in referring to it in the same
place, been unable to refrain from characterizing the bringing it
forward as a sign of insanity as puerile.
In France alone have been made 114 assaults on 93 persons, 57
of whom succumbed. Of these again 43 attempts were made on
26 persons with 1 1 fatalities in the nineteenth century. Excluding
the "false regicides," as Regis terms those assaults contemplating
rather notoriety than homicide, the attempts number 39 on 23
persons with 1 1 deaths, ^numbering 43 known assassins, participat-
*This excludes such cases as those of Marshal Brune, General Ramel,
POLITICAL ASSASSINS.— E. C. Spitzka. 73
ing in the former. Only 6 attempts with 6 participators of the
39 attempts with 43 participators (in the wider sense 10 of 47) are
represented in his paper, certainly in no sense an adequate pro-
portion to base comprehensive definitions and conclusions on.
True that one case well studied is worth ever so many figure-
heads posing in statistical array; but when sources, motives,
methods and consequences of acts are so far from being monoto-
nously uniform as they are with regicide, many cases require
analysis ; and the limited extent of the crime renders this no insur-
mountable task. How can a uniform definition be predicted for
the act of Tschech and that of Louvel ; or, take the unquestionably
insane, would any pen-picture of Schildknecht or Sefeloge suit
Verger, or one of Prendergast be applicable to Oxford ? Is the dis-
tance between Bellingham and Guiteau not as great as that between
persecutional delusional insanity and original megalomania can be?
Let us attempt to apply Regis's definition to a concrete instance ;
I shall take Bellingham's.
This test case is not a selected one, but taken hap-hazard as the
first in a list of diplomat victims of assassins. As great and
greater discrepancies are found in substituting for Bellingham,
McNaughton who, intending to shoot Peel, killed a subaltern;
Domenique Miller, who made the similar mistake regarding the
Mexican Consul fatal to Santi ; McNamara, who assaulted Blaine ;
Sangerly, whose delusion had well nigh proven fatal to the French
Ambassador Roustan; in short, this particular category among
nine insane assailants, contains no less than five who are not alone
undescribed in that definition but actually conflict with its terms.
DEFINITION OF INSANE ACTUAL FACTS IN RE-
REGICIDES PROPOSED LATION THERETO IN
BY REGIS. CASE OF BELLING-
HAM.
"Degenerates" Bellingham's father was noto-
riously insane.
"of a mystic temperament" *Nothing especially pointing
in this direction recorded,
"who, misguided by a political *The delusional concepts of
or religious delirium" Bellingham were of a mer-
cantile and financial charac-
ter intrinsically,
"think themselves called on Bellingham acted as judiciary
Victor Noir and Marshal Mortier, but includes the bomb throwers a la
Vaillant and Ravachol. Three others accompanied by fatal results are not
so figured as the persons killed were not directly aimed at, though aggre-
gating two score, namely Limoleon, Fieschi's and Orsini's.
74
POLITICAL ASSASSINS.— E. C. Spitzka.
to act the double role of
judiciary"
'and martyr ;"
"who, under the influence of
an obsession that is irresist-
ible,"
in his claim, deciding it
sound, after chosen umpires
had decided against him.
*Bellingham, so far from con-
templating martyrdom,wrote
his wife on the day of his
deed that he expected to be
released and visit her two
days later.
I question the applicability of
the "irresistible" and ob-
session in an alienist sense —
but as this is debatable will
merely point out that Bel-
lingham shot Perceval be-
cause he thought himself
authorized by the Home Of-
fice; "a morbid impulse"
stride sic dicta was not dis-
coverable.
Bellingham killed the Prime
Minister, Perceval, in 1812.
*It was in the name of none of
these, but of "Bellingham
first, last and all the time."
Possibly it could be inter-
preted as committed in the
interest of "justice" out-
raged in his person, as he
thought.
Judging by the fact that the occurrence of suicide or insanity
in a family is stated to indicate a positive taint in one paragraph,
(loc. cit. p. 140), and the nervous and mental disorders to which
regicides are subject are mentioned as common to the class in the
next one; Regis must regard ancestral suicides and insanity as
a Kismet dooming the offspring to the degeneracy complicated by
a dementia-terminating psychosis, which he defines as I have
quoted it. That such statements, rather by implication than
dogmatic assertion, though even this may occasionally be heard,
have been and are a source of immeasurable harm; harm, of
which the authors concerned have no conception, I am firmly
"kill some great personage"
"in the name of God, the
Country, Liberty or Anar-
chy."
♦Contradiction marked by asterisk.
POLITICAL ASSASSINS.— E. C. Spitzka. 75
convinced. The impression created in the minds of the relatives
of insane persons thereby is highly deleterious.
The number of people of refinement, and not infrequently of
talent and performance, who consult nerve specialists oppressed
by the incubus of the half knowledge obtained by the populariza-
tion of the chimera, painted in glaring colors, and named "degen-
eracy," must, judging by my personal experience, be a large
one. While it is preached by most alienists, that subjective worry
of this character, can not by itself provoke mental disease, I am
not so confident; for I recognize juggling with the mind, experi-
mental or through circumstances, as leading it near or into a terra
incognita the terminus whose paths one may not be always able
to anticipate. There are authentic cases on record, vouched for
by authorities like Westphal, of genuine psychoses resulting (in
non-predisposed persons) from dreams. I am unable to account
for still others unless I accept the influence of sensational impres-
sions in the waking state as adequate causes. Then, too, it does
not render their injurious influence any the less that those who
discredit the causative influence of apprehension and brooding,
add the qualifying clause "except in predisposed persons." Ac-
cording to the canons of heredity that proportion of the human
family is by no means an inconsiderable one, and hence it is one
whose interests surely weigh against those of a regicide whose
insanity is most problematical in many cases, if we grant that
those interests are furthered by exaggerating the overwhelmingly
malign powers of an hereditary influence. But aside from this
practical consideration, there is a question of scientific logic in-
volved. To infer and declare insanity from the fact that heredity
exists, imperfectly sustained, or altogether unsustained by clinical
evidence, as is done by more than one contributor to this discus-
sion, is inverted and fallacious reasoning. Physicians from time
immemorial noted the frequency of heredity; they concluded that
it was a most important, I, myself, go so far as to say the most
important predisposing factor. But physicians do not examine
family trees first and, tracing insanity through this or that or
several branches, predict that this or that twig will turn out the
bearer of insanity ; nor do they from the presence of insanity in one
line, telepathically discover its existence in collateral lines whose
members are miles away!
Suppose I have a large number of cases of tetanus in my prac-
tice, and it happens that a large proportion of those which have
occurred in my special district could be traced to the having
trodden on rusty nails; do I frighten every person who consults
me about an injury from the latter mishap into functional terror-
76 POLITICAL ASSASSINS.— E. C. Spitzka.
spasm, donning the mask of the tragical prophet-medical, and
predicting tetanus as prospective ?
Unless the allegation of insanity can be sustained by the life-
history and mental state of its alleged subject, somatic stigmata
and family histories, while warranting, nay, demanding registra-
tion, do not prove insanity. If the mental symptoms justify its
allegation, then indeed the latter appear as collateral evidence of
high value, for they reduce the possibility of simulation to the
very narrowest margin. Therefore, from those asserting the
insanity of historical characters, it can be rightfully demanded
that they present at least some convincing symptom or group of
symptoms, or action intrinsically suggestive of insanity. Unless
they do this, they may register the occurrence of a dozen suicides
or of a half-dozen insane relatives in the subject's family. It is
interesting and strongly suggestive, but it is not proof of insanity.
In recent medico-legal cases we encounter the "on dit" as sole
source of hereditary history over frequently. While its assertion
was not likely to have been of the same uncertain origin in former
days when, heredity not being appreciated, the motive for manu-
facturing or coloring a family record could not have been as
suggestible as it has today become, one may reasonably ask writers
for more definite statements than such which smack rather of
village gossip than historical annals or juridic register.
In this direction the shortcoming of some histories given in the
monograph of Regis, and in a large number in that by Talbot, are
such as to deprive a great part of their material of any convincing
value. Even of those cases regarding which the consensus of
opinion inclines towards assuming the insanity of an assassin
(Ravaillac, Damiens) the question arises as to whether in the
ordinary course of events the subjects would have been likely to
drift to the hospital, or whether their counterparts today would be
regarded as proper subjects for asylum treatment or legal curator-
ship. That their mental state has not been measured by the
standard of their contemporaries and in relation to their environ-
ment is a great stumbling block to accepting some of the conclu-
sions based on elaborate and painstaking researches. As else-
where shown, the strongest reasons for pronouncing Ravaillac
and Clement insane would justify declaring Catherine de Medici
to have belonged to the same category. And if implied criteria
deducable from Regis were strictly applied, all France, nay, all
Europe of the last half of the sixteenth and first half of the
seventeenth centuries must have been a cosmopolitan madhouse,
minus walls and caretaker.
It sounds a ridiculous truism, asking those who would establish
POLITICAL ASSASSINS.— E. C. Spitzka. yj
the departure of a mind from a given standard, to establish that
standard as a preliminary. But more ridiculous than the assertion
of any truism is the procedure of writers who render its assertion
necessary. Such have failed to familiarize themselves with the
'environment of regicides like Poltrot and Gerard, yet declared
them insane although these persons complied with the popular
standard as revealed to the more careful enquirers.
How far in ethics was the solitary murderer from the standard
of a day that saw the population of a great metropolis, old and
young, male and female, high and low, engage in the wholesale
assassination of their treacherously invited and disarmed guests?
How much can such assassin's moral principles have been per-
verted from the standard of a day when teachers and manuals
inculcated the conditional justifiability, if not the duty of regicide?
Did the humbler classes see any other — to them comprehensible —
statecraft, than assassinations, ambushments, tumults, Kings and
Queens conspiring against great lords, and great lords returning
the royal compliment? Neither on the score of legal nor of ab-
stract morality therefore can a regicide be pronounced a gross
departure from the normal standard of the day of St. Bartholo-
mew fame. I will suppose the advocates of the insanity of the
assassins named admitting their inability to maintain this partic-
ular position, and to fall back on the morbid "rage" displayed by
.Clement "when the 'Huguenots' were mentioned." The party
whose members conducted themselves as described in the follow-
ing was the dominant one in France, and hence the majority; in
what respect did Clement's rage differ from the "frenzy" of this
majority?
"The common people in France hold that there are no people
more wicked and criminal than heretics (Huguenots) generally as
long as they are a prey to the blazing faggots the people around
them are excited to frenzy and curse them in the midst of their
torments, says a contemporary historian."*
If this extract indicates Clement to have been "of the people" in
this "rage" matter, the great men of the day had not risen to a
higher level. We may therefore assert it to have been in the
line of the general conduct of all classes. To give an individual
example, a chronicle cited by Guizot elsewhere, states that Guise,
hearing that there were a number of Huguenots in a church at a
town in Champagne, "began to mutter and to put himself in a
white heat, gnawing his beard as he was wont to do when he was
*Sleidan, quoted by Guizot.
78 POLITICAL ASSASSINS.— E. C. Spitzka.
enraged or had a mind to take a vengeance." Is this "rage"
better or worse than that of Clement?
The frame of mind in which a regicidal act is conceived, may
be best studied from declarations made at the time of its matura-
tion and always before its accomplishment.
Sometimes a letter written prior to the attempted crime permits
a glimpse of the innermost psyche of a regicide. The following
manifests a delicacy of feeling and solicitude for others, scarcely
compatible with the prevailing conceptions of real lunacy. For the
Ego of the insane, whether in subjective self-abasement or ex-
pansive self-aggrandizement, is too exclusively dominant to permit
other egos beside itself — even the simulating such altruism by
lunatics seems to me a difficult conception.
Sheppard, having conceived the idea that it would be a praise-
worthy action to kill the King of England in 1718, wrote this
letter, which he intended for a nonjuring minister of the name of
Leake, but mistaking the spelling, he directed it "To the Rev.
Mr. Heath." This letter was in the following terms:
"Sir — From the many discontents visible throughout this kingdom, I in-
fer that if the prince now reigning could be by death removed, our king
being here, he might be settled on his throne without much loss of blood.
For the more ready effecting of this, I propose that, if any gentleman will
pay for my passage to Italy, and if our friends will entrust one so young
with letters of invitation to his majesty, I will, on his arrival, smite the
usurper in his palace. In this confusion, if sufficient forces may be raised,
his majesty* may appear; if not, he may retreat or conceal himself till a
fitter opportunity. Neither is it presumptious to hope that this may suc-
ceed, if we consider how easy it is to cut the thread of human life; how
great confusion the death of a prince occasions in the most peaceful nation ;
and how mutinous the people are, how desirous of a change. But we will
suppose the worst * * * * that I am seized, and by torture exam-
ined. Now, that this may endanger none but myself, it will be necessary
that the gentlemen who defray my charges to Italy leave England before my
departure; that I be ignorant of his majesty's abode; that I lodge with
some whig; that you abscond; and that this be communicated to none.
But, be the event as it will, I can expect nothing less than a most cruel
death; which, that I may the better support, it will be requisite that, from
my arrival till the attempt, I every day receive the Holy Sacrament from
one who shall be ignorant of the design.
"James Sheppard."
The letter exhibits a fairly correct view of the political situation,
one which sound writers regarded to have been most critical at
that very period. Above all, it shows behind the not unnatural
posing as self,devoting martyr, a sufficiently sanguine survey of
the chances of escape. Sheppard contemplates the following such.
First : there is "this confusion" in the midst of which he contem-
plates the appearance of the new sovereign for whom his dagger
POLITICAL ASSASSINS.— E. C. Spitzka. 79
shall have that moment cleared the throne; his safety and more
than mere immunity were then assured. Second: the people are
"mutinous" so that failure or success, indifferently, leave him the
chance of a rescue. The chance of capture and punishment he
regards as the less likely one of three for anent it he says: "But
we will suppose the worst"
Advocates of the opposing view may unearth the fact that
Sheppard was betrayed by a stupid error committed in directing
this very letter. Blunders are committed by every criminal, how-
ever; it is notorious that counterfeiters of marvellous skill almost
invariably make a false copy of some trivial feature, and so clum-
sily and stupidly as to appear startling to a child. While there-
fore entirely consonant with the general experience anent criminal
stupidity, it is not altogether unparalleled in legitmate undertak-
ings by good citizens, even of the highest intellect. I need not
refer to State asylums for the insane, provided with "all modern
improvements," built on high hills, without a thought having been
given to the water supply. There have been theories evolved by
natural philosophers equal in their ingenuity, plausibility and
grandeur of conception to any human intellectual achievement
which are mere derelicts today through one apparently minute
flaw, but involving absurdity so patent that the school boy might
remark, "I could have done better myself."
I might be pertinently reminded here that, proceeding far
enough on this line of exclusion, I may find myself accounting in
the same way, for every single deed and every single incoherence
and fallacy of the insane, to be conceivable as an error of the sane
mind through misconception or misjudgment; and I would in-
stantly admit that it were difficult to find any isolated deed, opinion
or expression, characteristic of the one, incompatible with the
other. But there is a world of difference revolving on that single
word "isolated;" for I would admit Sheppard insane if it were
shown that his error in addressing the letter had been one of a
chain of errors arising in this wise: Living in days when con-
spiracy was rife and rebellion had just been suppressed, the
Guelph tenure still a precarious one, it happens that Sheppard
experienced a strange subjective feeling, which is interpreted by
him as of supernatural origin; in some forbidden meeting of his
co-religionists he hears a reference to the arm that shall be blessed
for striking down a second Caligula, Caesar, Holofernes or Henry
of Navarre. Regarding this as a special hint intended for himself,
he perceives in a few street brawls a "mutinous people," regards
others who appear to look at him significantly as sworn sympa-
thizers, is particularly impressed with the fact that one of them
go POLITICAL ASSASSINS.— E. C. Spitzka.
enters the house of a non-juring clergyman, learns his name, right
or wrong, and, jumping at conclusions as to his identity, is con-
vinced that he has discovered the Providence-designated channel
for communicating with the Pretender. Such a person does not
need any additional idea, such as selecting a seat on high, next
the Redeemer, to constitute him insane, using an old apothegm
"to his fingers' ends." But almost any one of the above singly,
barring the initial sensation, is supposable in a sane person and is
certainly insufficient to prove insanity's existence.
Barrett is another witness against Regis as regards self-
immolating tendencies of political assassins. He had arranged
an alibi in advance and of such a character that I shall let the
account of Fitzgerald speak concerning the effect it had on most
who heard it.
"The prisoner was allowed to deliver an extraordinary, impassioned
address, of a native dignity and pathos, that was scarcely in keeping with
the crime for which he had been convicted. In fierce and bitter terms he
denounced the witnesses and approvers who had appeared against him.
'Never,' he said, 'did he feel the supreme degredation if his country till
that day/ He protested, but in guarded terms, his innocence. But he
was going away to a land where justice would be done him, and those
who had inflicted this wrong on him would have punishment meted out to
them. A deep impression was made on all who listened, and some had un-
easy suspicions that such a calm and dignified demeanor could only be
compatible with innocence."
"There was much discussion as to the conviction, and many were im-
pressed by the ingenious alibi. So earnestly pressed were these objections,
that a respite of a week was granted ; while commissioners were despatched
to Glasgow to inquire into the alibi. This took up more time than was
anticipated, and the respite was extended to another week. It was found,
however, that the alibi did not gain by the examination."
Ignorant and impoverished men are easily dazzled by the
display of money on the part of agitators and their agents, and
particularly so when the exhibitor is lavish thereof to them. This
factor is said to have been the one employed in conjunction with
the mystery of secrecy and terrorism of mysterious threats to
secure and bind the services of men who could be depended on to
place the explosives and combustibles of the conspirators* con-
ducting the Tower, Parliament and London Bridge explosions at
those places.
If in these cases are illustrated the operation of fellowship and
bribe-inspired courage or desperation driven by systematized ter-
rorism, there are others in which appeals to a gentler passion as
* Gallagher, whom I saw on his return from England, a pardoned insane
man, suffered from a characteristic hallucinatory psychosis, the recognized
sequel of solitary confinement.
POLITICAL ASSASSINS.— E. C. Spitzka. 8l
disharmonious with a bloody purpose as may be, succeeded. Bar-
riere, a poor boatman of the Loire, infatuated with a girl "em-
ployed in the household of Madame de Valois," is "won over by
her to the views" of that noble house. Fanaticized by his love
for the girl and the sermons to which she entices him, he sharpens
the steel with which he will attempt what Chastel, Mignon and
Ferrand missed and Ravaillac achieved ; too loud in the fulness of
an enthusiastic and fiery heart, and overheard, he is apprehended,
convicted and put to death with all the horrible circumstances of
a regicide's execution.
Among sane regenticides the conspiring variety includes a
number actuated by a motive which, on first sight, appears so
unreasonable to the popular view as to suggest unsoundness in
itself: the fascination which the accounts of trials and executions
of other regenticides exert on some youthful minds. I need not
devote any space here to combatting its supposed pathological sig-
nificance. We have the confessions of conspirators of this and
related classes showing such impressions and their strangely fas-
cinating influences to be far from uncommon enough to be re-
garded as pathological exceptions. One such instance is that of
the organizer of the Fuller plot ; he states his having, when young,
fallen in with a pamphlet containing an account of the life and
horrible death of another conspirator; that his imagination was
set on fire, and ever after was haunted by a presentiment of a
like fate.
That a large proportion of regenticides suspected, with some
reason, of having been the instruments of others ; or of having had
accessories behind the scenes; have resolutely contradicted these
charges, and resisted both extremes of suasion — the torture as
well as contingent executive clemency — is too readily accepted as
a proof of their act having been that of a single mind. The
reasoning which to the accused, condones the falsehood on his
dying lips, is one familiar to students of history ; it has been termed
Jesuitical, but it was the reasoning of Protestant fanatics as well
as of their opponents. Party fanaticism which nerved the arm,
equally tied the tongue and sealed the lips; the same ingenuity
which contrived the plot, contrived the fiction calculated, like the
dying serpent's last effort, to injure the foe. From the day when
Theodatus the Syracusan, under torture, deceived Hiero by a
spurious confession, which caused that tyrant to send Thraso, one
of his most loyal intimates, to the scaffold ; to the time of Fenwick,
whose confession to William III implicated exclusively the latter's
friends and chief supporters — have authentic demonstrations of
this been recorded? The bitterness of party spirit, the fierce
82 POLITICAL ASSASSINS.— E. C. Spitzka.
hatred of opponents, increased by confinement, prosecution and
the imminent destruction of life, serve to fortify a stubborn humor
or vainglorious pride in conformity with the adopted fanatical
faith and the loyalty shown his party sufficiently to justify the
relying of the instigators on their security against betrayal by
their agent or dupe. So well was the association of these, from a
conspirator's point of view, desirable qualities with a certain class
of minds understood, centuries ago, that Longham, a Jacobite
agent, confessed his selecting the regicides employed against
William III,, among flighty and half-witted men, such being more
susceptible of fanatization and likely to prove blindly loyal than
others, and more easily consenting to undertake what a shrewd
calculator could not be induced to undertake for the most enor-
mous bribe.* Longham might have added that the bribes most
tempting to such, are the real or affected admiration of associates
and particularly the eulogization by those prompting chiefs, who
happen to be the eidolon of the dupes' hero-worship. Substitute
for the Jacobite cause, that of Anarchy; for Barbesieux or Lou-
vois, Louise Michel or other self-supposed "Jeanne d'Arc" de-
voted to it ; for William of Orange, the collective heads of repub-
lics, empires, kingdoms and great industries; then subject this
same dupe to their influential environment, and you have a Bresci,
a Czolgosz or a Berkman. Nor need you all this apparatus for
certain natures instinctively brutal ; those glorying in malice, mis-
chief and the misery of others, require but little preparation to
become Hoedels, Lucchinis or Reinsdorfs.
This brings me to the subject of the role played by the various
factors susceptible of analysis in the national and other tragedies
here considered. The figures accumulated in the rubric of regenti-
cide, construing that term in its widest sense, making no discrim-
ination between high and low, military or civilian, royal noble,
burgher or serf, taken from all readily accessible records of all
times and lands — and which is yet very far from a complete one —
is 720, of whom 78 were of the female sex. On excluding those
whose position rendered their punishability out of the question,
and consequently gave them a status contrasting with the typical
assassin as well as those who assassinated at and in such opportune
moment and circumstances as to make them immune, the number
shrinks to 221 assassination plots, the actors in which are repre-
sented in the tables by 277 names.
{To be concluded.)
*Macaulay's History of England, Chapter XIX,— also note to same
chapter.
THE GENESIS OF EPILEPSY CLINICALLY CON-
SIDERED. THE PATHOLOGY, PROPHYLAXIS
AND TREATMENT OF EPILEPSY.
ILLUSTRATED BY CASES AND STATISTICAL TABLES.
BY LOUISE G. ROBINOVITCH, B. ES L. (PARIS), M. D.
Foreign Associate Member Medico-psychological Society, Paris; Member New York
Academy of Medicine.
(Continued.)
We have, up to now, followed closely the stepping stone to epil-
epsy in the progenitor. We have seen that the parent afflicted with
vertigo or epileptiform attacks of an alcoholic nature is very apt to
give birth to an epileptic offspring. More, we have brought to
light a great biological fact which is a valuable clue to our study :
the same parent may engender perfectly healthy children, entirely
free from convulsions — before he indulges in alcoholic drink;
whereas after the establishment of the alcoholic habit the contrary
takes place — the child born under these new conditions is generally
a pathological being, very apt to have epilepsy ; some of the alter-
native fates of such children are death during infancy, either from
inflamed meninges or convulsive ailments.
This tends to show not only that the primary root of epilepsy
lies, in a large number of cases, in a pathological cerebral condition
of the progenitor's brains, a condition induced by the abuse of
alcohol, but also that alcoholic vertigo and epileptiform attacks in
the parent are the stepping stones to true epilepsy in the offspring.
The epileptiform attacks differ in their nature from the true
epileptic convulsions.
"Alcohol, in the long run, can bring about convulsions ; but they
do not appear in the form of frank attacks of epilepsy. Their
mechanism is altogether different. They are not like toxic epil-
eptic attacks developed under the influence of a special poison;
they are convulsive epileptiform attacks analogous to those seen in
general paralytics, the senile dements, the patients afflicted with
cerebral tumors, attacks depending on profound lesions already
produced in the nervous centres by the prolonged use of spirituous
beverages." ( Magnan) .
Although the above picture of chronic alcoholism is a grave
one as to its nature, it is yet possible to arrest the progress of the
convulsions due to alcoholism at that stage. If taken in proper
time, one subject to these convulsions may become free from them
84 GENESIS OF EPILEPSY.— Dr. Robinovitch.
and return to normal health by abstaining from alcohol. The clin-
ical fact is demonstrated in the case cited below.
Case IV. — Chronic alcoholism. — Acute alcoholic delirium with
painful hallucinations of sight and hearing. — Epileptiform attacks
directly dependent on excessive ingestion of alcohol. — Tzvo chil-
dren born before the alcoholic habit was acquired are healthy. Free-
dom from epileptiform attacks during periods of abstinence from
alcoholic drinks.
M. E., 29 years old, plumber, was admitted to the Admission
Bureau, Ste. Anne Asylum, September 10, 1898. There is no his-
tory of his antecedents. He married when 25 years old ; he did not
have the alcoholic habit then. Two children were born within the
first five years of married life and both are healthy. The patient
began to indulge in alcoholic excesses, however, and soon left his
wife. He consumed daily from 2 to 3 "absinthes" and a litre of
wine. The acute effects of alcoholism were not slow in showing
themselves. On his first admission to the Admission Bureau,
December 14, 1892, he suffered from acute delirium: his hands
trembled and he had painful hallucinations : a snake, which was
visibly growing into larger and larger proportions, was going to
encircle him. He saw a bomb of dynamite upon the window sill,
and a multitude of rats danced in circles around the bomb, which
could explode at any moment, etc. These acute symptoms dis-
appeared, after a three months' period of total abstinence and
water regime. On his discharge from the asylum, however, he
again indulged in alcoholic excesses and entered the Ste. Anne
Asylum June 13, 1893. There was a repetition of the clinical pic-
ture of acute alcoholic delirium : trembling of the hands, painful
hallucinations of sight and hearing; his body was going to be
crushed into mortar, etc. A new period of water regime and
abstinence soon brought him through his attack. On October 3,
1893, he was arrested on the street where he was incoherently
shouting: "He will die in the ocean of his little king. . . .
Long live the Empress of Darkness. . . ." When brought to
the Ste. Anne Asylum, his hands trembled, he imagined he was
going to be guillotined, crucified, swallowed by wild beasts, jumped
upon by elephants ; wolves were precipitating themselves upon him,
phantoms, enormous persons — giants, all tried to harm him. Rats
were running after him. His friends only derided him and even
threatened him with violence when he appealed to them.
Up to this time the patient only suffered, on the whole, from
acute alcoholic disturbances ; the more permanent effects of the
poison on the brain tissue have been insidious in onset. For,
although no other symptoms were manifested than those of acute
GENESIS OF EPILEPSY.— Dr. Robinovitch. $5
alcoholism, a radical change had already taken place. In 1895, at
the age of 36, the patient suddenly fell without any warning, in an
unconscious condition and had a convulsive attack. He was
picked up and brought to the Admission Bureau. On awaking,
he was astonished to find himself there and had no recollection of
what had happened to him nor what had caused him to be brought
to the ward. All that had transpired from the moment he had
fallen to the time of his regaining consciousness, was a perfect
blank to him. He remained in the asylum six months, under a
water regime and a system of total abstinence, and no convulsions
took place. On being discharged, he resumed indulgence in al-
coholic excesses. Five months of this life helped again bring about
the necessary condition of the brain to favor the occurrence of
convulsions. And, indeed, at the end of that period he suddenly
fell in an epileptiform attack. Without any warning, he lost con-
sciousness and fell to the ground in clonic convulsions; he was
picked up in this condition and brought to the Admission Bureau.
When he regained consciousness he was again astonished to find
himself in the ward and had no recollection of what had happened
to him nor how he had come to the asylum. He made a long stay
in the wards, under a water regime and total abstinence. His
health improved while under this care; he had no convulsive at-
tacks during that period of time. The injured brain tissue seemed
to have regenerated. The patient was given his liberty and he be-
gan to drink again. After two months of alcoholic indulgence he
fell in an epileptiform attack. A shorter period of alcoholic in-
dulgence now sufficed to cause an attack to take place.
The patient was again brought to the Admission Bureau in an
unconscious condition. On regaining consciousness all was a rev-
elation to him : the fall, the convulsive attack and his trip to the
asylum. The water regime and total abstinence were again carried
out to the advantage of his health, and the brain resumed its nor-
mal condition ; there were no convulsive manifestations during his
present stay in the asylum.
Seeing the remarkable demonstration of the direct relation, in
this case, between the alcoholic excesses and the occurrence of
the epileptiform attacks, the physician cautioned the patient most
earnestly against further indulgence in drink. The patient, after
making a good recovery in the asylum, obtained his discharge and
abstained from drink for quite a period of time, while at large. He
remained free from epileptiform attacks during that period. His
will power soon failed him, however, and the habit again reasserted
itself. Within a few weeks after alcoholic indulgence, he had an
attack of painful delirium ; multitudes of snakes were intent on
85 GENESIS OF EPILEPSY.— Dr. Robinovitch.
stinging and devouring him; horses, lions, tigers and bears were
jumping at him ; he shut his eyes not to see them, but to no purpose.
The painful visions were far worse at night or when the room was
dark. Frightened into terror, he ran out into the street naked and
fell to the ground in an epileptiform attack. The convulsions
once over, he gathered himself up and began promenading about
the reservoir of the Place Daumesnil, where he was arrested and
then brought to the Admission Bureau, January 28, 1898. His last
admission to the asylum was, under the usual circumstances, in an
unconscious condition, September 10, 1898.
Case V. — Chronic alcoholism. — Delirium of persecution. —
Epileptiform attacks directly traceable to the influence of alcohol.
— Absence of convulsions throughout the period of one year's
abstinence.
G. L., 57 years old, entered the Admission Bureau, Ste. Anne
Asylum, June 16, 1898. His father died of gastritis; he was
not an alcoholic, but had a quick temper. The mother died at
the age of 59, of a cancerous growth in the abdomen ; she was ad-
dicted to alcoholic excesses.
The patient had a normal childhood, was intelligent at school
and at the age of 14 entered, as apprentice, the shop of a wood
gilder, remaining in that trade until he was 20 years old. At that
time he commenced to drink. He now changed his occupation,
becoming a launderer. At the age of 24 he married, but continued
to indulge in alcoholic excesses. He suffered from nightmares,
trembling of the hands, vomiting in the morning, and occasional
spells of alcoholic delirium. Still, this was no warning to him and
he continued in the alcoholic excesses. When 35 years old, he had
the first marked alcoholic delirium : he saw in his bed innumerable
persons who wished to kill him ; great military battles were being
carried on in the bed also ; he felt and saw the blood shed ; there
were ferocious beasts trying to swallow him; serpents encircled
him ; apes and rabbits jumped upon him ; fishes swam about him,
and rats gnawed his flesh. The delirium once over, the patient
resumed the abuse of alcohol and he soon began to suffer from
marked cramps in the legs and arms. In 1887, he had the first
marked spells of dizziness and vertigo. These symptoms were
only forerunners of a graver pathological condition which was to
succeed. On March 22, 1888, the patient fell suddenly, without
any warning, in a convulsive attack. The second one took place
a year later, in 1889. He was 37 years old now. His physician
warned him against the abuse of alcohol and succeeded in fright-
ening him. He therefore stopped drinking, abstaining from alco-
hol throughout the years 1889- 1890. He had no epileptiform at-
GENESIS OF EPILEPSY.— Dr. Robinovitch. 87
tacks during that period of abstinence. Finding himself healthy
under this regime, he weakened in the resolution to remain tem-
perate and resumed indulgence in drink; this he did with much
zeal, as his appetite was the more whetted from the period of
abstinence. An epileptiform attack soon surprised the patient, but
he kept on drinking; another attack occurred in the same year,
( 1 89 1 ) . He did not now try to resist drink, abandoning himself to
the alcoholic habit. He had three attacks in 1892 and many others
every year following. In June, 1898, he was taken to the Hospital
Charite, to be treated for gastric disturbances. On that night he
had a severe epileptiform attack and was transferred the next day
to the Admission Bureau. He was actively delirious and heard a
voice say : "Gustave, come with me, I love you," etc. It was always
a strange woman's voice that he heard address and defend him.
His wife's voice, on the contrary, bemoaned his fate.
I think that I have demonstrated fully that epileptiform con-
vulsions are due, in a vast number of cases, to the abuse of alco-
holic drinks. This fact is well known to the clinician. It has
also been shown that the alcoholic subject can rid himself of epil-
eptiform convulsions by abstaining from drinks, and that epilepsy
in the offspring is traceable directly to parental alcoholism in a
vast number of cases. The exact numerical extent of this will be
given later on.
The value of these truths is of much clinical importance. For,
indeed, if epileptiform convulsions of alcoholic origin in the parent
are genesic elements of true epilepsy in the offspring, then have
we reached the knowledge of the primary origin of epilepsy.
The primary origin of epilepsy, therefore, as brought out in this
paper, is alcoholism. In the parent it causes epileptiform attacks ;
and the descendant of such parents is apt to be epileptic in a vast
number of cases. It is of interest to note in this connection, and
the fact has already been referred to, that alcoholic parents who
have given birth to epileptic, idiot or imbecile children, with or
without other pathlogical stigma, can give birth to normal children
if the parents abstain from alcoholic drink during a long period of
time before conception takes place.
The reverse side of this biological phenomenon is also true, as
every physician knows: perfectly normal parents, with no path-
ological family record, have been known to give birth to epileptic
and other degenerate offspring, if one or both parents have in-
dulged in drink at the period synchronous with the conception of
the child.
{To be continued.)
THE TRANSFORMATION OF CRIME AND THE
MODERN CIVILIZATION.
Research in Criminal Statistics.
Inaugural Address at the Law School, University of Lausanne.
BY ALFREDO NICEFORO.
A philosopher has said that the history of civilization is the history of
human suffering. The author of this aphorism had, no doubt, a deeper
and truer conception of civilization than is the one generally adopted. The
majority thinks that, by virtue of civilization, evil and crime will slowly
disintegrate, making room for the birth of goodness, justice and felicity.
Civilization has always been judged with extreme optimism. The masses
think of civilization as of something analogous to the sunrise. According
to that notion, evil makes room for goodness, just as the night shades dis-
appear before the light of the rising sun.
This conception of progress and of civilization is, if I am not mistaken,
a profound error of sociological optics.
Civilization does not suppress evil; it transforms it. Not only this,
but every special form of civilization brings with it its special forms of
crime. Civilization has its infections and its leprosy, — in the physical as
well as in the moral domain; it has its crises of tears and paroxysms of
pain, just as it has explosions of boilers and wreckages of trains.
Modern civilization has dismissed the extent of mortality, reducing it
from thirty-one per cent, at the beginning of the last century, and bringing
it down to twenty-seven per cent., which represents the mortality figure
of to-day. It has elevated the level of intellectual culture and we owe to it
the discovery of the telegraph and steam; but at the same time it has
brought us an increase of certain forms of crime and suffering.
Insanity is on the increase and the statistics show us an alarming pro-
gress of the disease. Suicide is progressively on the increase. Both sui-
cide and insanity are venomousi plants nurtured by the flourishing of
contemporaneous civilization.
It is civilization, then, that is causing suicide, — the wreckage of the will
power, and insanity, — wreckage of the intelligence. Consequently, evil and
suffering do not evaporate under the burning flame of human progress;
they only become transformed. And crime, that first-born of evil, is
subject to the following law: It is immortal, and ever takes on new forms.
Among the transformations of crime brought about by civilization are
the following: Crime, which was enacted in the barbarous society by
violence is accomplished in modern society by means of fraud.
Barbarous criminality is simply transformed into modern criminality.
The works of Bjorson (LE JOURNALISTE), Balzac (MAISON
NUCINGEN), and Annunzio (L'INNOCENTE) show us the fraudulent
character of the crime of to-day; those who stole and killed with the
TRANSFORMATION OF CRIME.— Niceforo. 89
sword yesterday, attain the same aim to-day according to the tortuous
ways of the hour, without staining the hand with blood. Crime by steel
has made way for crime in white gloves.
In order to bring my statement out more clearly, I need only refer you
to the statistics of criminality in Italy, where above all other countries,
there is a large field for the study of crime.
In 1880, homicide, the most exact index of crime of violence, reached as
high as 16 per 100,000 inhabitants. In 1897, the figure fell to 12. That is to
say, that during the last twenty years, homicide has diminished in the pro-
portion of 100:75. We also find a diminution in the infliction of corporal
wounds, which has diminished from 296 to 271 to the same number of
inhabitants; extortions are lowered from 14 to 9; brigandage without
homicide is decreased from 3 to 1 ; usurpation and incendiarism have
decreased from 132 to 114.
On the contrary, offences of fraudulent nature have increased to an
enormous proportion. Swindling has increased, from 1880 to 1897, from 58
to 74; bankruptcy and commercial frauds, — from 3 to 14; counterfeit of
documents and money, — from 45 to 47 ; frauds in commerce, — from 3 to 16 ;
calumnies and forgeries of public documents, — from 8 to 16.
Thus, it may be said that during the last twenty years, the typical
crime of violence, — homicide, has diminished one fourth, and that offences
of fraudulent nature, on the contrary, have increased one fourth. The
rest of criminality, said to be of violent nature, is on the side of fraudulence.
As will be seen, the following formula may safely be given: Under the
pressure of modem civilization, crime of violence diminishes, making place
for fraudulent crime, which is augmenting.
It is not difficult to understand the cause of this transformation. If I
am allowed to draw a comparison, I wish to say that criminality resembles
the medusa, this sea animal, which, colorless by itself, takes on the color
of the water in which it finds itself. Crime, by analogy, having its roots
in the society in which it exists, takes on the form and color of the society
in which it exists. Thus, there were crimes of the violent type in the society
based on a principle of violence, — the ancient society ; crime of fraudulent
nature, — in the society of fraudulent principles, — modern society.
This law of the transformation of crime under the influence of modern
civilization explains admirably the geographical distribution of crime.
In the United States, the geographical distribution of the typical crime
of violence, — homicide, is instructive to that effect. In the North and the
East, where civilization is most developed, statistics show that there are
only six homicides per 100,000 inhabitants. In the South, on the contrary,
where pastoral life predominates over that of civilization, the number of
homicides reaches 12 per 100,000 inhabitants. In the central states the
figure goes up to 23 and even 28; brigandage is a very frequent crime there.
One might summarize the foregoing by the statement: The least civil-
ised countries tend toward having a higher percentage of violent crimes
than those most civilised.
As for crimes of the nature of frauds, — in Italy the following numbers are
given per 100,000 inhabitants : 79, in the country ; in Rome, 164, in Naples,
154 and in Milan, 108.
To summarize again, it might be said that: The cities tend to furnish
a lower number of crimes of violence than do the villages, but the cities
furnish a- higher number of fraudulent crimes.
GO TRANSFORMATION OF CRIME.— Niceforo.
An analogous phenomenon is observed in the study of the distribution of
crime of fraud and of crime of violence in the higher and lower social
classes.
As civilization is always more developed in the higher than in the lower
classes, the form of crime in the respective classes is that of fraud in the
former and violence in the latter.
Even when the proletariat class is uplifted to the standard of the higher
class, criminality does not disappear in the former ; it is only transformed.
The researches on the last question might be formulated thus: Riches
and plenty do not diminish crime, but transform it. In the poor, crime
is manifested in the form of violence, while in the rich it is seen in the form
of fraud.
The preceding demonstrates that crime continues to exist regardless of
the welfare of a nation. Crime will always exist, as long as humanity
exists.
Not only is crime being transformed with the progress of civilization,
but the criminal acts and kinds are also transformed. The juvenile criminal
is substituted for the adult and the feminine for the masculine.
Modern civilization tends, then, to augment juvenile and feminine
criminality.
Within the last few years the increase in the rate of juvenile criminality
in Italy has been 4% ; in France, $g% ; in Germany, during the 4ast ten
years, 29%; while in Austria, Hungary, Holland, Denmark and Sweden
the figure reaches as high as 48%.
The function of civilization in this phenomenon is that of shortening the
period of childhood and hastening that of adult age, the child becoming a
man before he has been a boy.
Indeed, the best demonstration of the precociousness of childhood is the
prevalence of suicide among children to-day. Recently, some fifteen boys,
from twelve to fifteen years of age, had committed suicide in London in
the course of one week.
The feverish life induced by civilization is also responsible for the
feminine criminality. It has increased 25% within the period of 1890-
1895. The most civilized nations furnish the largest number of criminal
women: France, 15% of those arrested; Austria, 13%; Belgium, 15%, and
Holland, 9%.
The crimes of to-day should be classified according to their kinds, as
the scientist's classification must naturally differ from that of the layman.
There is a variety that constitutes a crime in all countries and at alt
time; this variety includes murder, rape, parricide and brigandage.
These crimes might be designated by the term natural crimes
Another variety of crimes, however, is that designated by part of a society
that stigmatizes the acts of the other part as crimes ; this variety might be
called legal crimes. As civilization progresses there is a parallel progress
in the transformation of legal crime (an artificial product due to the gov-
ernment of the minority) into natural crime (La Scuolo Positiva, Nos.
11-12, 1901).
The Journal of Mental Pathology,
Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. II. MARCH, 1902. No. 2
STATE PUBLISHING COMPANY, Publishers,
290 Broadway, NEW YORK.
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28 West 126th Street, New York.
Address bulky mail matter to P. O. Box 1023, New York.
This Journal is published monthly, except in August and September.
Price of subscription, $2.50 per annum. Single copies, 50 cents.
Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope. News items from Institutions will be given all space
available.
THE EVOLUTION OF CRIME.
We publish in this issue an abstract of a study of the Transfor-
mation of Crime and Modern Civilisation. On reading this article
one is impressed with the fact that it has been written by a learned
student, who, unhampered by preconceived ideas, looks facts
straight in the face and states them as he sees them. The reason-
ing of this author regarding the influence of civilization on crime
is most instructive. As civilization progresses, he claims, the
lowest criminal manifestations, expressed by acts of violence, be-
come transformed into acts of fraud. Laws are so many expres-
sions of the moral standard of the society that creates the laws.
Democracy, called by Balzac "dirty-handed giant," is the most
active transformer of laws, and consequently of crimes, leading
Society to a higher moral level from day to day. But crime will
alzvays exist, the author assures us; taking on that transformed
appearance which is in harmony with the social coloring of the
day.
While one must accept the author's statements regarding the
main points of his argument, there is one point which we cannot
accept without some slight protest. As has been stated above, we
g2 EDITORIAL.
are told that crime is constantly undergoing a process of trans-
formation, the most horrible forms of crime decreasing rapidly
and being replaced by crime of higher development, — fraud. But
crime will always exist, we are told, so long as life itself exists.
This latter statement seems to us to be paradoxical, because it
is suggestive of fatalistic notions rather than of scientific synthesis
of the very facts so ably analyzed for us by the author. We concede
that frauds, as recently exemplified in the United States by the
army-supply cases, the postal frauds in Cuba and the numerous
bank defalcations by "eminently respectable" citizens are psychic
manifestations that should be designated by the term "crime."
But we are of opinion that the conclusion regarding the eternity of
crime, even under its most refined forms, is too hasty, if this
conclusion is based on the transitory form of criminal acts at a
stage of gigantic process of transformation of a date so recent as
is that of our civilization. Metamorphosis in things human re-
quires time — a great deal of time ; has it not taken centuries for
the monkey to become transformed into the highest living being
known to us to-day ? It were rash reasoning, then, to pick out a
certain state at an early stage of transformation and say: "The
eventuality must be similar."
Our civilization is as yet barren, recent and unformed, bowing
under the oppressive weight of barbarism, while we smile sardon-
ically and hypocritically, hesitating as a child does before taking
the first independent step, — fearing to loosen hold on what was,
yet longing to enter into what is or should be. It is in human
nature to pine for the unknown ; for that constitutes the subtle
feeling called happiness. And as progress implies constant change,
we move on, hastening, in our eternal search, to the temple called
civilization, within the walls of which, we are told, is held the balm
that heals all wounds.
STATE CONTROL OF THE FEEBLE=MINDED IN INDIANA.—
In 241 families with two or more generations of feeble-mindedness there
were found 970 persons who were blood relations. The number of direct
descendents who are feeble-minded is at least 726. The Secretary of the
Indiana State Board of Charities, Amos W. Butler, says in part: The
solution of this problem lies in an intelligent and general knowledge of
the subject by the public, preventive measures by legal marriage restric-
tions and other means, the education of feeble-minded children and the
custodial care of feeble-minded women (Amer. Medicine, Jan. 18, 1902).
HABITUAL DRUNKARDS IN LAUBEN.— The names of habit-
ual drunkards in Lauben, Silesia, are printed, and a list is given to every
saloonkeeper. Any person supplying intoxicant drinks to those subjects
is liable to a heavy fine (Med. Rec, Feb. 8, 1902.)
STUDY OF STEREOTYPIAS. 93
A CONTRIBUTION TO THE STUDY OF STEREOTYPIAS.
DR. A. CAHEN makes a thorough review of the bibli-
ography and classification of stereotypias and states, in part, that :
Stereotypia is almost always found to have originated with a
delusional idea. Wernicke has made a point of this fact. Ideas
of grandeur and especially those of defense and persecution are
the delusions pre-eminently apt to be the causes of those phe-
nomena. The ideas of grandeur and those of persecution, ap-
pearing late in the course of psychic diseases, when the mental
condition is dulled, the will power enfeebled and the consciousness
decreased in degree, are quite compatible with a condition of
stereotypia. The idea which is eventually responsible for the
manifestation of stereotypia is a conscious one at first, the patient
being able to give account for this or that movement or action.
With the course of the disease, the stereotypias develop hand in
hand with the delirium. This is observed in many cases. Among
many other cases, the one at Bicetre has the following history in
support of this view: When fifteen years of age, the patient be-
came subject to spells of choking; he did not lose consciousness,
but felt literally asphyxiated. In order to relieve himself during
those spells, he made a practice of sitting down in a chair and
either turning his head from side to side or from above downward.
At that time the patient suffered from mental excitement and
over-estimation of self, beating his mother and declaring that he
was above all the rest of the world. This delirium remained
uniform during a period of some thirty years ; he thought himself
above Gambetta and spoke with disdain about Victor Hugo. His
haughty feelings were expressed by corresponding external atti-
tudes. His chest was thrown forward, the head was held high,
the hands upon the thighs and the eye fixing his interlocutor.
When 45 years of age he still made a practice of assuming the
above described attitudes and of repeating the movements of the
head as he was wont to do when a boy, but he could give no rea-
son for the deed ; he was then a complete dement.
The different theories relating to the stereotypias may be cited
and criticized as follows :
Certain stereotypias are reflex (Binde). But a reflex act is
a movement in response to a peripheral excitation of a sensory
nerve. Stereotypias are not always originated in the peripheral
organs or the spinal cord.
Some claim that these phenomena are manifestations of atav-
ism ; but this is a fallacious supposition ; the acts being rather those
of instinct; the instinctiveness shows to great advantage when
the personality properly speaking is effaced.
94
INDIVIDUAL STATISTICS AND HEREDITY.
Those who hold that congenital cerebral enfeeblement is the
cause do not explain their thought thoroughly.
Stereotypias occurring in precocious dementia deserve notice
when following catatonia. In the early stages of catatonia there is
no regularity about its manifestations, no systematization of the
acts. But take the patient at the end of the disease, and stereoty-
pia is manifested in the typical manner: the patient is then a
dement.
The stereotypias are particularly marked in cases of secondary
systematized delirii. Dr. Seglas reports such a case in which the
patient had his vocabulary reduced to one absolutely stereotyped
phrase, summing up his whole delirium in a few limited words.
Cotard's patient had a still more contracted vocabulary, which
consisted of the word "no" of which he made use on all occa-
sions.
In the differential diagnosis of the various tics, the stereotypias
observed in hysteria and in epilepsy are of clinical importance. In
hysteria one finds periods when the manifestations are absent;
this is a valuable sign in the diagnosis of the affection. In the
epileptic, the total unconsciousness of the acts speaks for their
nature. (Arch, de Neur.x 1901.)
ON THE SIGNIFICANCE OF INDIVIDUAL STATISTICS
IN THE QUESTION OF HEREDITY IN N EURO — AND
PSYCHOPATHOLOGY. — DR. STROHMAYER reports this
study in the Munch. Med. Woch., XLVIII, 45, 46, 1901. The
families of 56 patients were studied. The number of members
was 1,338 in all; 413 (30 per cent.) were found to suffer from
psychopathic or nervous diseases; 251 (18.6 per cent.) were
neuro — or psychopaths; 595 (41.5 per cent.) were healthy; 42
(3 per cent.) were debilitated children; 55 (4 per cent.) were
suicides ; the number of healthy members in the individual fam-
ilies fluctuated between 0.87 per cent. Those who remained
healthy up to the time of death amounted to 30 per cent. As to the
special heredity when it is either paternal or maternal — nothing
definite can be stated about that point. This is certain, however,
when the heredity comes from both parents, the offspring's in-
sanity is of graver form than when there is heredity on one side
only. Psychoses which have arterioschlerosis for their basis are
inherited by the male members preferably (alcoholism). Mi-
graine and hysteria predominate on the woman's side. Generally
speaking, heredity is polymorphous in its working. Homologous
inheritance is seen mostly in cases of melancholia (in 5 families
with 164 members, 30 were melancholiacs), mania, hypochondria,
CEREBRAL TUMOR OF PSYCHO— PARALYTIC FORM. 95
epilepsy (in one family there were 7 and in another 12 epilep-
tics), migraine, chorea, hysteria, and alcoholism. Physical stig-
mata of degeneracy are inherited to a marked degree (in one
family which consisted of 23 members in the course of 5 genera-
tions, 15 members had discolored irises, besides epilepsy and
insanity in the fourth generation). In cumulative heredity one
finds mostly the forms of psychoses which were formerly desig-
nated as degenerative — paranoia, juvenile insanity, periodic in-
sanities, anxious forms, feeble-mindedness, in a word — malforma-
tions and mental debilities. Strictly speaking, Morel's schema
is not always applicable. The author knows of families all mem-
bers of which are abnormal, without any one member being prac-
tically insane; in other families the degeneration came to an end
without there being any apparent reason for the phenomenon.
The practical influence of alcoholic heredity is noteworthy: In
16 out of the 56 families examined there was an alcoholic parent
at the head (Schmidt's Jahr. der in-und Aus. Ges. Med., Helft
12, 1 901.)
A CASE OF CEREBRAL TUriOR OF PSYCHO— PARALY-
TIC FORM (SENSORY APHASIA AND RIGHT HEIII-
PLEQIA.)— MM. J. ABADIE and L. DEPIERRIS report this
case in the Jour, de Med. de Bord. The case is that of a large
cerebral tumor which developed within the left hemisphere, the
corresponding clinical symptoms being of psychic and paralytic
nature.
The patient was fifty years of age and neither the heredity nor
the personal history are of clinical importance.
A few weeks before death, some slight mental disturbance set
in. There was loss of memory, defect of application and, while in
the street, one day, a slight apoplectiform attack took place, with-
out there being any loss of consciousness or paralytic phenomena ;
the only disturbances that followed were complete hebetude and
some disturbances of speech.
The first examination of the patient was made on the day fol-
lowing this attack. The face was expressionless and bore a look
of astonishment ; there was no paralysis of the face or limbs. The
sensibility to pricking was abolished almost over the entire sur-
face of the body. There were no disturbances of the special
senses. ,
The patient did not speak spontaneously; he had no verbal
deafness ; his answers to questions were slow and incomplete.
Paraphasia was marked, the designation of objects called by name
being done incompletely. The recognition of objects was incom-
96 CEREBRAL TUMOR OF PSYCHO— PARALYTIC FORM.
plete, but that of people — exact. The patient could not write
spontaneously under dictation, neither could he copy writing.
Alexia was almost complete; he seemed absolutely indifferent to
his surroundings.
The splanchnic organs were normal. At no time during this
illness did there exist vomiting, headache or delirium.
A second examination was made one month later.
The sensory aphasia had become complete ; the verbal blindness
and deafness were absolute — the designation of objects was im-
possible and their recognition abolished.
A third examination was made five days later and it was
found that right hemiparesis of the face and limbs had made an
insidious onset without there being any phenomena of contracture.
The paralyzed hand was cedematous and the aphasia was com-
plete; the patient remained speechless, but his general condition
was good.
Nine days later the general condition was quite impaired, the
right hemiplegia was total and complete and there was hemianes-
thesia on the same side.
The patient died ten weeks after his admission to the hospital,
without having presented any phenomena of pain worthy of
record.
At the autopsy the viscera were found to be normal. In the left
cerebral hemisphere was found a voluminous tumor, the size of
an orange, developed at the expense of the external part of the
lenticular nucleous, compressing the inferior parietal lobule, the
Rolandic operculum, slightly the foot of the third frontal and es-
pecially the convolutions of the insula, which was pushed aside
and flattened. This tumor could be enucleated with ease and
was surrounded by some softened cerebral tissue, but there were
no adhesions.
The posterior half of the lenticular nucleous and the optic
thalamus had disappeared almost completely ; the internal capsule
was not destroyed, but was flattened.
The histological examination of the tumor showed that it was
a glio-sarcoma with a predominence of sarcomatous cells.
In view of the symptoms presented by the patient during life —
slight apoplectiform attack, incomplete sensory aphasia at first,
and total aphasia later as well as progressive right hemiplegia — it
was logical to suppose that there was softening of the cortical
region of the gyrus angularis and of the insula, and that the
cortical motor zone became involved secondarily. The autopsy
showed, however, that the question here was not that of a cortical
lesion, but of a central one ; not of softening, but of a tumor.
CEREBRAL SYPHILIS— GENERAL PARALYSIS. 97
During the development of this tumor there were no dis-
turbances of function of either the organs or the senses, neither
were there any visceral troubles — vomiting; there was even an
absence of headache, which is a usual accompaniment of cerebral
tumors.
The presence of the tumor was characterized by psychic dis-
turbances only; defective mental application, verbal blindness,
paraphasia and verbal deafness, a condition of persistent hebetude
and by paralytic symptoms — total and progressive right hem-
iplegia with hemihypoaesthesia of the same side.
This case should enter into the group of cerebral tumors of
psycho-paralytic form as described by MM. Brault and Loeper in
the Archives Generates de Medecine, March, 1900.
The authors of this paper differ, however, from those cited
above as to the pathogenic action in such cases: it is reasonable
to suppose that the symptoms were due to pressure by the tumor
rather than to the neoplasic invasion, as those authors would have
us think.
In discussing this case, the following remarks were further
made:
The hemianesthesia, or more properly, the hemihypoanaesthesia,
on the side opposite the one where the tumor was located, must
have been due to the encroachment on the optic thalamus.
M. Verger remarked that in such cases the diagnosis>is confus-
ing. There is verbal blindness and yet the centre of verbal blind-
ness is intact. There is verbal deafness and yet its centre is
intact also. In such cases, one invokes somewhat obscure reasons.
Goltz, for instance, holds that inhibition has an active part here.
It is difficult to explain these facts and the pathogenesis of symp-
toms of hemianesthesia of cerebral origin remains to be explained
(Gas. des Hop. de Tout., Dec. 21, 1901.)
CEREBRAL SYPHILIS SIMULATING GENERAL PAR-
ALYSIS.— Jacksonian Epilepsy, Dysarthria, ocular paralyses. —
DRS. E. BRISSAUD and ALPH. PECHIN publish this case. It
presented the classical symptoms of general paralysis ; some multi-
ple and contradictory ocular symptoms, however, led to the suppo-
sition that the disease was located in the base of the brain. An im-
portant point in the diagnosis of such difficult cases is the fact that
cerebral syphilis of the convexity of general paralysis is incompat-
ible with gommata and sclerous syphilitic changes of the base of
the brain. The patient is 43 years of age, highly educated and en-
gaged in high financial business. He had contracted syphilis in
1887, and was treated for it at that time. In 1898, 21 years after
g8 cerebral syphilis—general PAkALYSIS.
the infection, the disease manifested itself for the first time, in the
manner described below.
He began to suffer from headaches, which were localized on the
left side, in the temporal bone and in the posterior region of the
parietal. On July 22, he had an epileptic attack (Jacksonian),
which was preceded by disturbances of sight (broken luminous
lines before his eyes). During the succeeding few weeks he was
doing well, excepting that he suffered from headaches in the left
supra-orbital and temporal regions. September 18, he had a sec-
ond attack of Jacksonian epilepsy which was preceded by a right
brachial aura, while he was reading the daily paper; the printing
looked to him like Mirror Writing. A third attack took place
November 10; this was preceded by motor aphasia. Judging from
the disturbances of speech observed, it may be supposed that the
disturbance was not sensory, as is stated. The fourth attack took
place March 23, 1899, and was also preceded by motor aphasia.
The general health kept up in fairly good condition, and the fifth
attack, preceded by an auditory aura and hallucinations of hear-
ing (strains of music), took place June 1. The disease became
severer from that date, as the attacks were not followed now by
periods of intermission. The sixth attack took place July 10th,
and the seventh on July 14th, the articulation of speech being very
defective, and characteristic of paralytic dysarthria. The tremors
of the tongue, however, were not typically vermicular in nature.
His physiognomy was typically expressionless and there was
clipping of words ; he listened to orders given him by the phy-
sician, but could not execute them, although he seemed anxious
to do what he was told; asked to write his name and address, he
traced some unintelligible lines. The pupils were large and un-
equal, the reflexes exaggerated — especially on the right. July 14
and 22, there were two more attacks, followed by marked motor
aphasia and after the last attack, paresis of the right arm set in;
a slight degree of the same trouble was noticed a year previously.
In July, 1899, specific treatment was instituted and the patient
seemed to benefit by it quite considerably. The ocular manifesta-
tions now made their appearance and enabled us to eliminate the
diagnosis of general paralysis.
At the beginning of August, diplopia without strabismus ap-
peared; two and one-half months later (October 15), the complete
paralysis of the right sixth pair was followed by slight ptosis of
the right upper lid and mydriasis on the same side. He was em-
metropic and had insufficiency of accommodation of the right eye ;
consequently there was partial and incomplete paresis of the third
pair. There were no alterations of the retina. Sight was nor-
THE NATIONAL MENTAL HEALTH AND THE WAR. gg
mal. The iris reflexes, feeble on the right, but normal on the left.
Accommodation on the right impaired. The fourth pair was in-
tact. The right lid showed spasmodic contractions, especially
when the patient's attention was not attracted to the fact. There
was, besides, right facial paresis and complete deviation of the
uvula to the left. The lower limbs had not been attacked. There
were no psyschic disturbances. The taste and movements of the
tongue were normal. All the movements of the lower jaw were
normal; consequently, there was integrity of the lingual, glosso-
pharyngeal, great hypoglossal and the motor branch of the trige-
minal.
The cause of this affection was now evident : there was a syphil-
itic arteritis of the base of the brain, especially in the circle of Wil-
lis, and thus the complex symptoms co-existed. It is of interest
to note that in this case the development of the disease was quite
late in making its appearance: — 22 years after the infection took
place. The third, sixth, seventh and tenth pairs were here in-
volved. This is not astonishing when one considers the predilec-
tion of the syphilitic poison for the arteries of the base of the brain.
The epileptic attacks with periods of intermission, transitory
symptoms, right brachial paresis, motor aphasia, etc., were due
to circulatory disturbances brought about by a temporary obliter-
ating arteritis of the left Sylvian artery. In cases of this kind
there is always the possibility of obscuring of symptoms by reason
of gommata and infiltrations indiscriminately situated. Statis-
tics on similar cases with reports of autopsies show that one can-
not always adjust the symptoms to the topographical diagnoses.
The patient has improved under treatment and is discharging his
daily duties. (Progres Med., Jan. 18, 1902.)
From the Journal of Mental Science, January, 1902 :
1. THE NATIONAL MENTAL HEALTM AND THE WAR
—Statistical reports on asylum admissions in Ireland, Scotland
and probably in England, tend to show that there has been a
decrease in the number of insane admitted during the period of
the last war. Similar facts were observed during 1870, in France,
and in 1 861, in America. The war is looked on as having acted as
a national mental tonic.
2. A CASE OF EPILEPSY FOLLOWING TRAUMATIC
LESION OF PREFRONTAL LOBE—Drs. URQUHART and
ROBERTSON publish this case. The patient's sister was an
epileptic. When eighteen years of age the patient sustained a fall,
receiving injuries to the head and remaining in an unconscious con-
dition, in consequence, for some weeks. Two years later epil-
100 TWO CASES OF LIPOMA OF THE BRAIN.
epsy of a severe nature set in, the patient dying in status epilepticus,
twelve years later. The autopsy revealed the fact that the anterior
part of the frontal lobe of the brain was the seat of softening, —
doubless the result of a hemorrhage that took place during the
fall sustained by the patient.
Similar cases have lately been reported by Drs. Angiolella,
Ventra, Pastrovitch and Modena. The reports of these cases will
be found in: Annali Di Nevrologia, 1898, p. 2JJ\ Rivista Speri-
mentale Di Freniatria, 1900, p. 896; Rivista Sperimentale Di
Freniatria, 1900, p. 723.
3. TWO CASES OF LIPOMA OF THE BRAIN ADELE DE
STEIGERT, M. B., publishes these cases. Case I, suffered from
epileptic attacks at long intervals, the last ones having set in five
weeks after the birth of the tenth child. The patient died in the
asylum of pneumonia. The autopsy showed that there existed a
lipomatous tumor; it lay over the corpus callosum, and curling
around the knee there was a firm mass. It was one-fourth of an
inch thick and the length was that of the corpus callosum. In
the choroid plexus of the right ventricle was also a firm yellowish
nodule about the size of a split pea. Microscopically, both masses
were found to consist entirely of adipose tissue, enclosed by a
capsule of fibrous tissue, thicker in some parts than others. Be-
tween the tumor and the corpus callosum was some very gritty
material, apparently a calcarious deposit.
Case II was that of a man, thirty-one years of age, who died in
the asylum of general paralysis. He was an alcoholic. There was
a convulsive attack involving the left side ; paralysis of the left arm
and leg persisted. During the course of a year there was a repeti-
tion of the attacks, the symptoms predominating on the left side.
The autopsy revealed the presence of the usual appearances in
such cases of a thickened dura with wasted gyri. There was,
besides, on the right side, over the superior parietal lobe, a patch
of softening; there were granulations in the floor of the fourth
ventricle. A tumor was found over and adherent to the posterior
perforated space; the growth was hard, yellowish and about the
size of a small bean. Microscopically, the neoplasm consisted of
adipose tissue, with numerous blood vessels and a distinct capsule
of fibrous tissue. Lipomas are rarely found in the brain.
4. NOTES ON THE PREFRONTAL LOBES AND THE
LOCALIZATION OF MENTAL FUNCTION. —Dr. P. W.
MACDONALD makes a cursory review of the theories regarding
the localization of the centre of intellectual function in the brain.
Some hold that the prefrontal lobe is the seat in question, while
DEGENERATION OF THE OPTIC THALAMI. IOI
others incline to the belief that the occipital lobe is the part of the
brain thus endowed, Dr. C. Clapham being one who supports
the latter view. The author of this paper is a believer in the
"frontal' ' theory and demonstrates his view by a specimen of a
brain of an idiot. In this brain there was a marked want of devel-
opment of the frontal as well as of the prefrontal lobes, the empty
space thus created in the cranium being rilled out by an exagger-
ated thickening of the cranial bones. In this connection, attention
is called to the fact that in general paralysis, which is character-
ized by dementia, the mid and fore brain are affected most. The
prefrontal theory is further argued from the statistics below: of
forty idiots and imbeciles, in twenty-five instances, the brain was
of fair size, with no marked deficiency, but much irregularity in
the convolutions ; twelve showed marked irregularity with arrested
development in the prefrontal lobes; in two cases the occipital
lobes were small and defective, and in one instance both prefrontal
and occipital lobes showed defective development and irregularity.
5. DEGENERATION OF tHE OPTIC THALAHI. -Dr. J. B.
BLACHFORD made a preliminary communication on four cases
with degeneration of the optic thalamus. All the cases had a record
of syphilis, the knee jerks were brisk in three cases and absent in
one ; sensation was normal in two cases ; the gait was not ataxic in
three cases and ataxic in one; the pupil reflexes were absent or
sluggish in three cases and normal in one ; the vision was defective
in two cases and blindness existed in the other two. Mentally, the
cases were those of mania, and three cases of dementia. In one
case only was the diagnosis verified by a post-mortem examination
which showed that the optic thalamus was degenerated, the
anterior corpora quadrigemina being involved to a lesser extent.
One is justified in attributing to the same cause the blindness in
the other three cases, as the symptoms are very much alike ; par-
ticularly, as the cases improved under specific treatment. Syphilis
is at the root of this disease ; it is found more frequently in men
than in women and the ependyma of the ventricles is found to be
granular, especially that of the fourth, a condition very frequently
found in general paralysis.
Anatomically, one is astonished to find that in these cases,
especially in the one where the autopsy proved the existence of a
lesion of the optic thalamus, there was no general trunk anaesthe-
sia ; yet the filet carries up all sensory impulses, except the visual
and olfactory, the central, or spinal, filet receiving all the sensory
impulses from the trunk terminating in the optic thalamus. The
pupillary phenomena can be explained in a way. If the anterior
corpora quadrigemina are chiefly reflex ganglia, and the optic
I02 NOTES ON HALLUCINATIONS.
thalamus-intercalary ganglion, between the optic tracts and the
visual centre in the cuneus, then the predominance of visual over
reflex symptoms or vice versa will depend on the centre that is
first affected.
The role of the optic thalamus is sensory, according to Sellier
and Veryer, but this does not include sensibility to pain. Dr.
Engel published a case of tumor of both thalami, in which there
was complete loss of taste and smell on both sides, deafness in
both ears and sudden blindness in both eyes ; death ended the case.
6. NOTES ON HALLUCINATIONS — Dr. NORMAN makes
some general remarks on hallucinations of the senses, laying
special stress on hallucinations of hearing in the ear that is deaf.
This variety of hallucinations has been observed by many psychia-
ters; Calmeil commented on them sixty years ago; Brierre de
Boismont makes mention of the same in his textbook. Ball and
Regis have written on cases of hallucination in the ear that was
affected with otitis media. Mabille described a case of this kind
in which the hallucinations ceased on the removal of a foreign
body that was lodged in the auditory canal and that caused the
hallucinations. Raggi reported a case of a drunkard who had
unilateral auditory and bilateral visual hallucinations. In another
old woman there were unilateral hallucinations of the right eye
that was affected by a cataract, on the removal of which the hallu-
cinations ceased, only to reappear in a worse form. It is possible
that functional disease is more liable to appear in a centre thrown
out of gear. The author reports a case where unilateral auditory
hallucinations were due to plugging of the auditory canal with
cerumen. But the patient had bilateral hallucinations of many
other senses, which fact makes it difficult to explain the unilateral
hallucination.
7. CASE OF UNILATERAL HALLUCINATIONS OF HEAR-
INO, CHIEFLY flUSICAL; WITH REMARKS ON
THE FORHATION OF PSYCHO-CEREBRAL IMAGES —
Dr. ROBERTSON publishes a case of a sane man who had
unilateral auditory hallucinations in the ear that was completely
deaf ; the right ear, although not perfectly free from deafness, was
free from hallucinations. The man is somewhat musical and
states that this disturbance began twelve years ago and has not
left him since that time. The sounds heard are like those of
orchestral brass instruments. The patient is aware of the fact
that the sounds he hears are imaginary. The defect of the left
ear, in which the trouble exists, dates back eighteen years. Dr.
Barr, in commenting on this case, states that one of his patients
FEMALE CRIMINAL LUNATICS. 103
heard constantly the tune of some hymn. The first appearance of
the hallucination followed a fall in which the head struck the
curb stone; there was no organic lesion in the ear. Dealing with
the formation of the psycho-cerebral images, the doctor mentions
that the repetition of certain neuron vibrations corresponding to
certain images predisposes the neurons to undergo the same
vibrations under some special morbid exciting causes.
8. FEMALE CRIMINAL LUNATICS.— Dr. JOHN BAKER
publishes a report on the subject alluded to in the heading, dealing
principally with the medico-legal side of the question. A compar-
ative table of brain weights of normal and insane criminal women
is given, showing that there is a progressive decrease of the weight
with age as well as with condition in the following order: Sane
women, homicidal subjects and lunatic criminals of acquisitiveness.
9. SOME CASES OF PELLAGROUS INSANITY Dr.
WARNOCK, of the Cairo Asylum, Egypt, states that between
the years 1896 and 1900, he had received 141 cases of pellagrous
insanity of which 92 were men and 49 women. The disease is
always accompanied by grave disturbances common to pellagra in
Egypt.
TUMOR OF POSTERIOR CENTRAL CONVOLUTION.
— Dr. SCHLAPP presented a case with the above mentioned
trouble to the N. Y. Neurological Society. The patient, a woman,
had had a fall five years ago, sustaining an injury to the left side
of the head. This was followed by attacks of loss of speech and
twitchings in the right arm and shoulders. Three years after the
accident, the twitchings had extended over the shoulder, and
neck to the face and tongue. Latterly she had suffered from
intense shooting pains in the limbs. There was astereognosis and
impaired tactile and muscular sensibility on the affected side.
There was no anaesthesia; the temperature sense was normal. It
was diagnosed that the patient was suffering from a tumor in the
posterior central convolution extending back into the parietal
lobe. An operation revealed the presence of a yellowish and
somewhat indurated area, about the size of a silver dollar, in the
posterior central convolution. The microscope showed that this
was not a tumor. Since the operation, the patient has had four
convulsions, but the strength in the affected hand has improved.
The case was presented as one having a bearing on the question
of astereognosis. In astereognosis the pain and temperature
sense are not usually involved, while tactile and deep muscular
sense are involved. {Bost. Med. and Surg. Jour., January 23,
1902.)
104
PARASITE OF EPILEPSY.
PARASITE OF EPILEPSY — Bra announces in La Press
Med. that in seventy cases of epilepsy he has found the blood of
the patient, before the attack, a parasite that he has not been able
to discover after the cessation of the attack. This microorganism,
which has been cultivated, has sometimes appeared as a coccus,
sometimes as a diplococcus, and sometimes in chains. (Med. Rec-
ord, Jan. 25, 1902.)
CALCIUfl IN EPILEPTICS.— Dr. L. Sabbatani, experiment-
ing on epileptic patients, came to the conclusion that if epilepsy
is due to auto-intoxication according to some, the specific auto-
intoxication is due probably to the fact of lack of assimilation of
indispensable elements; this defective function in the epileptic is
due to a decrease of calcium in the system, leading to excessive
irritability of the nervous centres, especially in the cortical region.
Based on this theory, experimental treatment was administered
to epileptics by giving them lime water mixed with milk ; the re-
sults were most encouraging. (Arch, di Psichiatr., Vol. XXIII,
Fasc. I.)
ON THE MENTAL DEVELOPMENT OF A CRETINOID
CHILD UNDER THYROID TREATMENT. — Dr. TH. HEL-
LER published the results obtained from thyroid treatment in a case
of sporadic cretinism. The patient's history is negative. When two
years of age he first showed symptoms of the disease and rapidly
losing his mental faculties, became an idiot. The thyroid gland
swelled up, the skin became thick, the extremeties cold, etc.
Thyroid treatment was given, in tablet form at first, then the
fresh gland. The first changes for the better were observed to
take place three months after the beginning of the treatment.
From that time on the improvement was gradual; to-day, one
year since the treatment has been commenced, the child shows
marked mental improvement, giving hope of a permanent recov-
ery. (Wien, Klin. Rund., February 2, 1902.)
TREATMENT OF ACROMEGALY WITH PITUITARY
BODIES.— Dr. KUH writes in Jour. Am. Med. Ass., February
1, 1902, that the results obtained from the administration of pow-
dered pituitary bodies in cases of acromegaly were satisfactory and
that the treatment deserves further study. (N. Y. Med. Jour.,
February 8, 1902.)
HUHAN ASYMMETRY.— Dr. W. S. ELY made a report on
this subject, stating that the adult man showed marked asym-
metry of body ; that during childhood this feature is not marked,
but that it developed with age. The asymmetry is seen in every
organ of the body; the brain showed the feature to a marked
INSANITY AND THE POISONS. 105
extent. Dr. MacDonald, commenting on the statement, remarked
that some scientists show too marked a tendency to consider
asymmetry in some subjects as signs of degeneracy. (Am. Med.,
February 15, 1902.)
INSANITY AND THE POISONS.™ Dr. MACLEAN, super-
intendent of the Eastern Washington Hospital for the Insane,
in developing his paper under the above title, states that he recalls
having heard Gen. Garfield say that man was "the joint product
of Nature and Nature." This was a pointed way of stating that
man was the joint product of heredity and environment. The
importance of good hygiene for the brain is urged and the various
ways of the penetration of poisons into the brain are considered,
such as alcohol, syphilis, etc. Eleven cases illustrative of the role
of alcohol in the genesis of idiocy and imbecility are quoted from
Dr. Robinovitch's paper, published in The Journal of Mental
Pathology, June and July, 1901, and the paper concludes with
consideration of autogenetic poisons in their relation to insanity.
(St. Paul Med. Jour., February, 1902.)
ON THE DETERniNING CAUSE5 OF THE FORflA-
TION OF THE VISUAL ORGANS. M. A. PIZON read a
paper on this subject at the Paris Academy of Science. The con-
clusions were that the phenomena of vision are the consequences
of accumulation of pigmentary granules in various parts of the
surface of the body, these granules having the property of absorb-
ing luminous rays. A gradual course of evolution leads on to the
formation of the perfected visual organs. (Prog. Med., January
11, 1902.)
HYDROCEPHALUS AND SMALL-POX. — M. SCHWAB
reported this case to the Obstetrical Society of Paris. The child
was born four months ago, with congenital hydrocephalus, the
occipito-frontal diameter measuring 54 centimetres. Several
punctures were practiced, but the liquid was reproduced rapidly.
The history of the case shows that there was no syphilis of the
parents, but that the mother had suffered from a severe attack of
small-pox while pregnant with the patient. (Progress Med., Jan-
uary 11, 1902.)
PROFESSIONAL TOXIC POLYNEURITIS. MM.
SOUPAULT and FRANCAIS mention two cases of peripheral
neuritis of the extremities which was caused by the use of benzine
in the dyeing business. M. Dufour says that in such cases cere-
bral manifestations mark the onset of the disease. (Progres Med.,
Nov. 2, 1901.)
Io6 GEOMETRICAL FORMS OF FACES.
GEOMETRICAL FORflS OF FACES OF NEAPOLITAN
DELINQUENTS.— Dr. A. DE BLASIO has made a study of
the facial forms and concludes as follows :
In Naples, the oval and normal ellipsoidal forms of face are
characteristic of normal subjects.
When the above mentioned forms are found to exist among the
delinquents, the latter are not of the worst type.
Modified outlines of the above named forms found among de-
linquents are generally either more elongated or shortened.
The lowest types have square faces.
The crime committed is generally in the inverse ratio to the
shortness of the facial rectangle.
Finally, the triangular, orbicular and the rhomboidal faces are
peculiar to subjects who practice petty thievery as a means of
making a living. (Arch, di Psichiatria, etc., Vol. XXIII, Fasc. I.)
SPELLS OF ANXIETY, EPILEPSY AND HYSTERIA
PROF. RAYMOND delivered a lecture on these subjects, stating
the difficulties one finds in making a correct diagnosis in complicated
cases. One patient, 13 years of age, became the victim of epileptic
convulsions after a fright, while at play with his school-mates. The
convulsive attacks set in on the day following the fright and had
kept up their appearance daily afterwards. The peculiar features
in the case consisted of the fact that the child did not always bite
his tongue nor urinate involuntarily during the spells. This led
to a search for the presence of hysteria and the examination re-
vealed that there were disturbances of general sensibility: On the
left arm was found a circular line of demarcation that divided the
upper third, — anaesthetic, — from the two lower thirds, — hyperaes-
thetic. There was anaesthesia and hyperaesthesia, in an analogous
manner, of all the senses.
Another case analyzed was that of tardy epilepsy, the origin of
which was arteriosclerosis. (Revue de UHypnotisme, Jan., 1902.)
THE SENSATIONS OF AN ELECTROCUTED PRO-
FESSOR.— M.A.BROCA'S experience of being severely shocked
by an electric current while experimenting with a Rhumkorff coil
is related in detail in the Gaz. Med. de Paris. He was holding
two electrodes, one in each hand, when he was thrown violently
to the ground; he did not lose consciousness, his thought being
directed to the imminent danger of dying of cardiac paralysis.
He tried to call for his assistant, but his voice had failed him. The
sensation experienced by him as described in his own words,
are as follows: "I had lost the sensation of possessing my limbs,
HYSTERICAL CRURAL MONOPLEGIA. 107
and the walls of the room seemed to incline to the right and to
become colored in green; then I lost consciousness, regaining it
after my assistant had cut the circuit. When picked up and made
to walk, I had a curious sensation that no part of my body ex-
isted excepting the head and legs. I did not feel pinching, and
the general sensibility was absent. The fingers, on the contrary,
were the seats of hyperasthesia. On touching a metallic ruler it
felt to me unusually cold and I withdrew my hand. It was some
fifteen minutes before I could move my fingers again, writing some
words with much difficulty. On attempting to walk, I was over-
come with dyspnoea. Some hours after I had returned to my
rooms, on the fifth floor, I was taken with a severe cardiac attack ;
one the third day after the accident, all unpleasant symptoms had
disappeared. (Revue de L'Hypnotisme, Jan., 1902.)
HYSTERICAL CRURAL riONOPLEGIA Dr. L. G.
SIMON publishes a case of hysterical monoplegia of which the fol-
lowing are the salient features: The patient was a boy, 13 years
of age; two brothers are invalids, one being treated for infantile
paralysis. Without any apparent cause, the child fell to the
ground, in a chill, retaining consciousness ; when he tried to gather
himself up it was found that he had paralysis of the left leg. The
child was taken to a hospital, and the evolution of the disease
showed that it was of hysterical nature. Sixteen days after his
admission to the hospital, he suddenly got out of bed and walked,
after some hesitancy of gait. He presented, on examination, nor-
mal tendon reflexes, and disturbances of sensibility to pain, heat
and touch that were quite characteristic of hysteria ; notably, there
was a variation and shifting, from day to day, of the intensity as
well as of the locality of the general sensibility. (Ann. de Med.
et Chir. Infant, Jan. 15, 1902.)
A CASE OF CEREBELLAR CONCUSSION Dr. CAM
POS-HUGUENCY publishes a case of a man who, during a fall in
which he struck his head against the curb stone, had received a se-
vere contusion of the right occipital region. This was followed by a
feeling of whistling in the left ear, tottering gait, forced move-
ments on the right and a dicrotic pulse. The author asks whether
it is not logical to admit the existence of commissural fibres of the
auditory nerve, disputed by some anatomists. He also asks whether
we should not conclude, from the symptoms found in this case, that
the cerebellum has a functional influence on the heart action. Of
the negative points, he mentions the absence, in this case, of dizzi-
ness. (Gazette des Hopitaux, etc., Jan. 11, 1902.)
I0g HEREDITARY EFFECTS OF ALCOHOL.
A STUDY OF THE HEREDITARY EFFECTS OF ALCO-
HOL. — J. M. FRENCH reports,, in Medicine, the following :
From the statistics obtained from various sources it is evident
that alcohol is the greatest cause of degeneracy, both mental and
physical. Inherited inebriety develops rapidly at the first excit-
ing cause. Such subjects are never moderate drinkers; they are
generally drunkards. This disease is difficult to cure and the
patient is apt to relapse. Of 814 children of alcoholics observed
by Legrain of Paris, 322, or 40 per cent., were degenerates ; seven-
teen per cent, were epileptic or hysterical. By adding 174 who
had not strength to survive, but died of infantile weakness and
debility, the percentage runs up to 61. Four per cent, showed
moral depravity. (Med. Record, Jan. 25, 1902.)
SIMPLE HYPERTROPHY OF THE BRAIN.-M. VARIOT
treated a child, 16 months old, who seemed to have had hydro-
cephalus, its head having measured 54 cent, in circumference. In
six months the circumference augmented 2 cent. The child died
with a temperature of 43 degrees C. At the autopsy there was
little fluid found in the brain ; the latter was of very large size and
firm to touch. The ventricles were not dilated unusually. The
brain weighed 1,640 grams. The hypertrophy seemed to be
simple ; the meninges appeared to be normal ; the convolutions were
apparently normal but their morphology seemed to be abnormal.
The cerebellum and medulla were not of exaggerated size. No
lesions were found, excepting pulmonary congestion. (Progres
Med., Jan. 18, 1902.)
THE PHENOMENON OF INHIBITION AND ITS POS-
SIBILITIES IN PATHOLOGY, ESPECIALLY IN ITS RE-
TATION TO THE DISEASES OF riYXCEDEflA AND EX-
OPHTHALMIC GOITRE. — Dr. S. J. Meltzer read a paper
under this title, at the N. Y. Academy of Medicine. He spoke
of the important part that inhibition played in many functions
of the body and suggested that in Grave's disease there was an
exaggerated degree of lack of inhibitory activity while in myxoed-
ema the contrary was the case. Commenting on this statement Dr.
Thompson remarked that as the tissues were found to be sur-
charged with a mucoid fluid, which acted on the muscular and
nervous functions very much as ashes do in the banking of the
fires of a steam-engine, it was questionable whether increased in-
hibition should be taken here for the sole determining factor.
(Medical Record, Feb. 22, 1902.)
CASE OF EPILEPTIC CONVULSIONS CAUSED BY A
SHOE BUTTON IN THE NOSE— Dr. STEELE published this
INSANITY IN THE COUNTY DISTRICTS OF ENGLAND. lQg
case in the Laryngoscope. The patient was a boy, six and a half
years old, who had been suffering from epileptic convulsions for
two years, having six or eight attacks daily ; the mind also became
impaired. It was found that the trouble was due to a shoe button
that was lodged in the nose, between the middle turbinate and
the septum, about the junction of the anterior and the middle
thirds. After the removal of the foreign body, the child became
free from the convulsions in the course of eight weeks. Two
years later the child was still free from the disease. (The Post
Graduate, Vol. VII, No. I.)
THE SURGICAL PAVILION OF THE PUBLIC ASYLUMS FOR
THE INSANE OF THE DEPARTMENT OF THE SEINE, AT THE
STE. ANNE ASYLUM.— The surgical pavilion at the Ste. Anne Asylum is
a culminating result of the efforts for centralization. The structure stands
isolated from the rest of the buildings and is constructed according to
the latest principles of modern surgery. The ground floor is occupied by
the operating rooms, maternity wards and surgical dressing rooms; the
basement is used for biological laboratories, sterilization of furniture, etc.,
and the second floor is occupied by dormitories. The operating room is
divided by a partition into a septic and asceptic parts. The scientific prin-
ciples of surgery are carried out to perfection by a strict division of the help,
utensils, etc. (Arch, de Neur. December, 1901.)
INSANITY IN THE COUNTY DISTRICTS OF ENGLAND.— The
Med. Press states that insanity appears to be greatly on the increase in the
rural parts of Great Britain and that some county parishes are perfect
hotbeds for the propagation of insanity. Intermarriage is said to be the
cause (Med. Record, Jan. 25, 1002.)
THE PSYCHIC STANDARD VERSUS THE AGE OF MARRIAGE.
— PROF. MARRO proves by statistical data that the subjects of countries
where servility is most developed marry at a precocious age ; in Russia mar-
riage is contracted at an age of complete immaturity, while in England and
the United States, where personal liberty is most developed, marriage is
contracted between the ages of 20 and 30. In Russia the woman marries
before the age of 20 years in 56% of the total cases. (LA PUBERTE.)
THE FUTURE OF THE NEGRO FROM THE STANDPOINT OF
THE SOUTHERN PHYSICIAN— Tuberculosis, syphillis and malaria
are very prevalent among the negroes. It is estimated that over 50 per
cent, of the negroes are syphilitic. The number of still-born children
is large in consequence; the negro also succumbs readily to pneumonia.
His tendency to crime also leads to the decrease of their number by
murder, the noose and the stake. As amalgamation with the white race
is denied him, his ultimate disappearance may be expected (St. Louis Med.
Rev., Feb. 1, 1902.)
AMUSIA, TOGETHER WITH A CASE OF INSTRUMENTAL
AMUSIA IN BEGINNING PROGRESSIVE PARALYSIS.— Julius Don-
ath reports in the Wien. Med. Woch., Oct. 3, 1901, the following: Memory
pictures of every melody, every text, and the power to sing, to play, etc.,
occupy separate areas in the brain. This explains the peculiar forms of
HO BOOK REVIEWS.
amusia that have been recorded. The history of a cretinoid child 2% years
of age is quoted, stating that the patient was an idiot, yet could sing fifty
different melodies, but not the words that accompanied them. The case
of instrumental amusia which the author reports is as follows: An illit-
erate gypsy musician about 39 years of age, while at supper, suddenly lost
his speech. When asked to play, he could play only a single melody and a
few chords besides ; and no matter what he was asked for, he played only
these selections. He was practically aphasic, and was unable to imitate
words or songs. He could not play the pieces that were played before
him, even though they had formerly been familiar to him. In time, the
ability to speak and to play on the violin returned. The preservation of the
power to play perfectly a single selection may be explained, the author be-
lieves, by assuming the intactness of the area in which the memory of this
piece is stored {American Medicine, Jan. 4, 1902).
BOOK REVIEWS.
DIE BEZIEHUNGEN DES NERVENSY5TEM5 ZU DEN
THR/ENENORGANEN, ZUR BINDEHAUT UND ZUR
HORNHAUT. — Ein Handbuch fur Nerven mid Augen-
aerzte, von DR. H. WILBRAND, Augenarzt, mid DR.
A. SAENGER, Nervenarzt, in Hamburg, Mit 49 Text-
abbildungen, 2d vol. of "Neurologie des Auges." /. B.
Bergmann, 1901, Wiesbaden. As the title of the book indicates,
this is a work destined for the oculist and neurologist. The vari-
ous ocular and facial paralyses with which one meets in practice
are graphically considered in their relation to the corresponding
nerves involved. The anatomy, physiology and pathology of the
lachrymal gland and the ocular nerves are presented with dexterity
as well as erudition. The function of the trigeminus is consid-
ered in its physiological and pathological relations, every statement
being supported by numerous clinical demonstrations. Herpes,
zoster ophthalmicus and keratitis neuroparalytica are considered
at great length and in a most instructive manner. The clinical
material is well tabulated for purposes of differential diagnosis and
are most helpful guides in difficult cases. The book is in hand-
some, 8-vo., with 859 references of works in the text, as well as
listed, and a handy alphabetic index of the subjects treated. Con-
sidering the insidiousness of the onset of ocular disturbances and
bearing in mind the great importance attached to the timely diag-
nosis of these symptims, every neurologist must, of necessity, be
familiar with this special pathology ; he cannot find a more helpful
textbook for this purpose than is this volume. The book has 324
pages.
BOOK REVIEWS.
Ill
LA PSYCHOLOQIE ETHNIQUE. Par CH. LETOUR-
NEAU, Secretaire General de la Societe d 'Anthropologic, Prof,
a TEcole d'Anthropologie, Paris. I vol. in -18, 556 pages, price,
6 francs. Schleicher Freres, Publishers, Paris. — This volume fol-
lows a large number of other works on ethnographical sociology
written by the author. The various races are considered from
the standpoint of their psychic development, beginning with the
remotest periods of existence. While tracing these psychic out-
lines, the author slips a step back, giving a relative analysis of
corresponding manifestations in animals, only to make the human
psychology understood more clearly. Step by step, the history
of civilization is led up to the present day, dissecting through the
veil of what is generally termed by the word of "idealism" (moral-
ity, religion, customs, etc.) with the knowledge and insight of a
learned scholar of many branches of science, art and literature.
On reaching the last page of the work one feels like saying with
the author : "How much ado has there been about the small mite
we have accomplished.' '.
The chapters dealing with the sexual ethics are both interesting
and instructing. Many tribes, struck by the phenomenon of
childbirth, went so far as to disregard the parentage of the father,
that of the mother only having been recognized. In Sahara,
woman was sufficiently alert to her generic importance to gain for
herself a lofty position as a social unit, and could have vied with
that of the progressive woman of our own day. From this state
of cerebration to that of accepting immaculate conceptions there
was only one step, and among many such conceptions was that of
Buddha, who incarnated himself in the loins of his mother Maya-
Devi, etc. At various stages of mental development there ex-
isted beliefs in immaculate conceptions of human beings through
the intercourse of trees, or else, as seen in the Greek mythology,
a father only was instrumental in such cases (Apollo, Minerva,
etc.). The Chinese, whose sexual immorality is notorious, and
who nevertheless profess profound esteem for chastity, have,
among numerous other legends of immaculate conceptions, one
that took place without participation by either father or mother.
When there was only one man and one woman, the story runs,
the woman refusing to sacrifice her chastity, the gods lit up such
an intense light in her lover's eyes and made her gaze so respon-
sive to his that a child was born from the exchange of those looks.
Among other phenomenal doings of woman, as recorded by his-
tory, is that of the Egyptian matron, who had the exclusive right
of divorce, the marriage being based on the servitude of the
husband.
112 BOOK REVIEWS.
The study of the correlation of religion to progress and civiliza-
tion is most instructive and many a thinking man will profit by the
reading of the religion of the Chinese in its relation to their
progress.
COS'E IL GENIO?— BY ADOLFE PADOVAN. Ulrico
Hoepli, Milano, 1901. The author deplores the fact that Lom-
broso considers genius to be intimately correlated with the various
degeneracies. The writer proves that this view is untenable and
adduces sound arguments in support of his opinions. If some men
of genius manifested various morbid symptoms either during the
period of childhood or during adult life, there are numerous men of
genius who were perfectly normal and free from disease, either
physical or psychic. Michel Angelo, Leonardo, Galileo, Spinoza.
Titian, Voltaire, Goethe and Manzoni are examples of the latter
types. A genius is born richly endowed with brain force and
perceptive power. Genius may be defined as being "Uno state
fisiologico di squisita, eccezionale sensibilita nervosa/' The little
volume has 62 pages and costs 1.50 lires.
THE NATHAN LEWIS HATFIELD PRIZE FOR
ORIGINAL RESEARCH IN MEDICINE.
The College of Physicians of Philadelphia announces through its Com
mittee that the sum of Five Hundred Dollars will be awarded to the author
of the best essay in competition for the above prize.
Subject: "The Relation between Chronic Suppurative Processes and
Forms of Anaemia."
Essays must be submitted on or before March first, 1903.
Each essay must be typewritten, designated by a motto or device, and
accompanied by a sealed envelope bearing the same motto or device and
containing the name and address of the author. No envelope will be opened
except that which accompanies the successful essay.
The Committee will return the unsuccessful essays if reclaimed by their
respective writers or agents within one year.
The Committee reserve the right not to make an award if no essay sub-
mitted is considered worthy of the prize.
The treatment of the subject must, in accordance with the conditions of
the Trust, embody original observations or researches or original de
ductions.
The competition shall be open to members of the medical profession and
men of science in the United States.
The original of the successful essay shall become the property of the
College of Physicians.
The Trustees shall have full control of the publication of the memorial
essay. It shall be published in the Transactions of the College, and also
when expedient as a separate issue.
Address J. C. WILSON, M. D., Chairman, College of Physicians, 3x9
South Thirteenth Street, Philadelphia, Pa.
BOOKS AND PAMPHLETS RECEIVED.
Prof. Raymond. CLINIQUE DES MALADIES DU SYSTEME
NERVEUX. Hospice de la Salpetriere (Annee 1897-1898, and 1898-1899.)
Quatrieme et cinquieme series. Deux volumes de 606 et 678 pages. Octave
Doin, Paris.
COMPTES RENDUS DU CONGRES INTERNATIONAL D'AN-
THROPOLOGIE CRIMINELLE. Amsterdam, 9-14 Septembre, edited by
Prof. J. K. A. Wertheim Salomonson, General Secretary of the Congress.
Dr. Luigi Cdppelletti. DI UN NUOVO IPNOTICO PEI MALATI
DI MENTE: Clorentone.
Bourget et Roux. MONOGRAPHIES CLINIQUE NO. 28. La gas-
troenterostomie. Masson et C-ie, Paris.
Dr. Antonio D'Ormea. UN IDIOTO MICROCEPHALO.
Dr. C. B. Mariani. ALIMENTAZIONE DEGLI ALIENATI SIT-
OFOBI.
Dr. Augusto di Luzenberger. SUL TRATAMENTO DELL 'IMPO-
TENZA SESSUALE.
Dr. G. Asselin. UETAT MENTAL DES PARRICIDES; ETUDES
MEDICO-LEGALE.
Dr. Felix Aughier. CONTRIBUTION A UETUDE DU RAPPORTS
DE LA PARALYSIE GENERALE PROGRESSIVE ET DE LA DE-
GENERESCENCE.
Dr. Stephen Pallut. DE LA SORTIE PREMATUREE DES ALI-
ENES.
Dr. Louis-Henri-Germain Grimaud. DE LA NEURASTHENIE SEN-
ILE.
Dr. Dusson. CONSIDERATIONS PSYCHOLOGIQUES ET MEDI-
COPEDAGOGIQUES SUR UN CAS DE DEGENERESCENCE.
Dr. Pierre Oudard. LE DELIRE D' AUTO-ACCUSATION.
Dr. Maillard. DE LA VALEUR CLINIQUE DU CYTODIAGNOS-
TIC CEPHALO-RACHIDIEN DANS LES CAS DOUTEUX DE PAR-
ALYSIE GENERALE PROGRESSIVE.
Dr. Efisio Murgia. LA VIRULENZA DEL DIPLOCOCCO NELLA
SALIVA DEL 'UOMO A SECONDA DELL 'ETA E DELLE STAG-
IONI.
Prof. Sano. LA RIFORMA DELL TNTERNAMENTO DEGLI ALI-
ENATI NEL RELIGIO.
Vol. II.
\\\\,mv.
No. 3.
The Journal of
Mental Pathology
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Dr. CHAS. K. MILLS (Phila.),
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ALBANEL, L., LL. D., President SoWjy family Patronagtf (5a/|s) ; BAILEY, Dr. P. (New York) ;
BAJENOW, Dr., (Moscow) ; BECHTElhSJ&rJPrjft. AR%j3>T BERILLON, Dr. Edgar (Paris) ;
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Prof., Editor Journal de Neurolgie (Belgium); DRILL, Dimitri, LL. D., Jurist Ministry of Justice
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TABLE OF CONTENTS
LEADING ARTICLES.
On the Fundamental Nature of the Delusional Ideas of the Insane,
Dr. G. Cesar e Ferrari 113
Political Assassins; Are They All Insane? Dr. E. C. Spitzka 121
The Genesis of Epilepsy Clinically Considered. The Pathology, Prophy-
laxis and Treatment of Epilepsy, Dr. Robinovitch 140
EDITORIAL.
Psychiatry and Law 149
Education and Crime 150
TRANSLATIONS AND ABSTRACTS OF CURRENT LITERATURE.
Experimental Researches in the Olfactory Sensibility in General
Paralysis 151
New Toxic and Therapeutic Properties of the Blood-Serum of Epi-
leptics, and the Practical Application of Those Properties 153
A Case of Circular Insanity, Alternating Daily, of Seven Years'
Standing, in a Subject Afflicted with Apoplectic Attacks, with
Remarks on the So-called Circular Neurasthenia 156
Acquired Hydrocephalus, Lumbar Puncture ; . . . . 157
Two Cases of Nicotine Psychoses 158
A Theory of Hallucination 159
Clinical and Anatomo-Pathological Studies of Idiocy 160
Three Cases of Acute Cerebro- Spinal Meningitis 161
Suicide in the United States 162
Renal Permeability of Epileptics to Methyl Blue 163
Insolation and Psychosis 163
The British Child Study Association 164
Overcrowding in Hospitals for Insane 164
Vienna Psychiatric and Neurological Society 164
Prince and Physician 165
Psychiatry in Goethe's Works 165
Some Facts Relating to the Illness and Death of Heine 165
The Depopulation of France 166
Depopulation in Berlin 166
BOOK REVIEWS.
Clinical Lectures on the Diseases of the Nervous System, Prof. F.
Raymond 166
N. Vaschide and CI. Vurpas. Psychol ogie du Delire dans les Troubles
Psychopathiques 168
Books and Pamphlets Received 3d cover
The Journal of Mental Pathology.
Vol. II. APRIL, 1902. No. 3.
ON THE FUNDAMENTAL NATURE OF THE
DELUSIONAL IDEAS OF THE INSANE.
BY DR. G. CESARE FERRARI,
Editor Rivista Sperimentale di Freniatria, Italy.
I shall try to demonstrate in the following pages that the nature
of delusional ideas is borrowed from the individual characteristics
of the subject himself. This will be made evident by a comparison
between delirious ideas of the insane proper and those caused by
intoxications, or infections, as found during the course of fevers.
According to Richet, the delirious states which follow intoxica-
tions, excitants, anaesthetics and narcotics are characterized by
hyperideation ; the latter is caused by the action of the poison on
the nervous cells, which preside over the intelligence.
Danillo (cited by Richet) confirmed these facts by his experi-
ments ; he showed that hallucinations and delirium, brought about
in animals by absinthe, disappeared as soon as the grey cortical
substance was removed. It would appear that the hallucinations
are the result of cortical paralysis. According to Richet, these
poisonous substances act thus on the brain because of their solu-
bility in fatty substances.
As alcohol is the most commonly used poison, I shall consider
its action on the human brain first.
The first effects of alcohol are those of a feeling of well-being, of
satisfaction with one's self, and of felicity. This condition of
optimism is followed by one of hyperideation — the result of intel-
lectual excitation caused by the action of the alcohol on the brain ;
the subject becomes a prey to a multitude of ideas which combine
with one another in rapid succession, having a characteristic com-
mon to them all — lack of proportion : the subject proposes to bring
into execution many acts, but at the same time he remains inert as
to action; all his activity is directed to the imbibing of more and
more alcohol, which, in its turn, decreases the thoughts of care, and
plunges the individual in a condition of beatitude ; at this stage, the
subject finds himself kindly disposed towards all around him; he
becomes confidential, confiding his secrets to the first person who
114 NATURE OF DELUSIONS.— Dr. Ferrari.
will listen to him ; he declares himself capable of brave moral acts,
etc.
As the quantity of liquor absorbed augments, the intoxication
increases, and the nervous centres finally become dulled, and
paralyzed, and alcoholic coma follows.
In short, the action of alcohol may be expressed as being an ex-
citant at first — the memory and imagination being in a condition of
exaltation; this exaltation may be ascribed to paralysis of the
selective attention and inhibition of the will power. This is the
reason, perhaps, that artists resort, sometimes, to the use of alco-
holic stimulants when vigorous imagination is required for their
creations, and when they wish to be enabled to give the imagina-
tion unrestrained sway.
This artificial excitation of mentality may sometimes serve to
whip up some dormant idea, but repeated indulgences of this na-
ture never lead to profitable explosions of useful intelligence. No
normal individual can claim truthfully that he has ever found alco-
holic stimulation helpful in co-ordinate or conscious reasoning of
any kind. This is due to the fact that alcohol is a powerful inhibi-
tory agent of the faculty of attention.
Chronic alcoholism also gives rise to delusional ideas, but they
differ from those manifested during the course of acute alcohol-
ism: in chronic alcoholism the delusions are pretty nearly alike in
all subjects ; the delusions during the course of acute alcoholism,
on the contrary, differ with every individual, according to his in-
tellectual culture. i ! ; '
In chronic alcoholism there are always the same clinical mani-
festations : malaise, mental depression and fear — all corresponding
to an enfeebled organism, which incapacitates the subject for any
work. The illusions which follow are generally dependent on the
enfeebled condition of the sense-organs ; the hallucinations, ideas
of persecution and zoopsia are also the results of enfeeblement.
OPIUM changes the general circulation of the brain, although
we do not know exactly in what manner. About half an hour after
the drug has been swallowed, the subject experiences a feeling of
well-being (i), which is followed by one of pleasant drowsiness.
Just before the drowsiness sets in, the subject feels that he could
be master of any situation, but he enjoys the sensation of rest too
well to take part in activity. The limbs become flaxid before the
intelligence shows signs of inactivity. Little by little, the mentality
also becomes effaced and is accompanied by incorrectness of per-
ception : near-by sounds appear as if they were struck at a marked
distance; the surroundings become more and more indistinct,
until they seem as if enveloped in a mist, the individual becoming
NATURE OF DELUSIONS.— Dr. Ferrari.
115
conscious of a great silence around him, and in which he feels as if
his body were almost immaterial. Ideation also changes: every
problem seems easy of execution, and life is seen in its best colors.
De Quincey compares the action of opium to> the capacity of the
bee to elaborate honey from the substance found in fat as well as
from the rose ; like the bee, opium seems to* dominate every situa-
tion, attuning to its tuning fork all circumstances.
All that surrounds the subject bespeaks a serene display far
above the vulgar scenes of every day life: precious metals, soft
and valuable stuffs and things in unison with royal purple abound
about him, and harmony of sentiment binds him to those near him.
These expansive ideas are not only characteristic of the intellec-
tual, but they are met with in the unintellectual people as well.
The period of pleasurable excitation is followed by one of som-
nolence. The subject is then in a perfect condition of beatitude,
nothing annoys him — everything seems harmonious to him; he
makes no attempts at action, satisfied with what seems to him to be
existing around him.
HASHISH, like the drugs above considered, also has a power-
ful modifying influence on the intelligence. The action of this
drug merits a close study from a psychological standpoint.
The effects of this drug are felt about half an hour after it has
been in jested. The subject experiences then a sensation of a
change in his normal condition : there are phenomena of motor and
sensory irritability in the spinal cord. There are acute pains along
the spine, in the neck and in the limbs. There is a sensation of
cold in the hands and feet, this sensation increasing gradually.
The subject experiences a desire to stir, and at that stage, a sensa-
tion of heat takes place in the head ; but all these curious manifes-
tations do not cause the subject any anxiety or preoccupation. He
seems, on the contrary, rather contented, and seems conscious of
the fact that he is in good humor ; he laughs on the slightest prov-
ocation, although he is quite aware of the fact that the incident
which has provoked his risibility is insignificant. This period of
easy risibility soon passes away and the subject feels serene again ;
he feels and knows that the action proper of the drug has set in.
Up to this moment the subject was yet a normal man ; but from the
time the substantial action of the drug sets in, the normal ideation
gives way to one that vies with the most unbridled insane imag-
ination.
Richet describes this state as follows :
"It is like a continuous performance of fireworks, a fountain of
lights that reach out in every direction : the ideas follow one an-
other with the rapidity of a whirlwind; the ideas come and go,
Il6 NATURE OF DELUSIONS.— Dr. Ferrari.
crowding one on the other without any apparent order ; but a close
examination shows that all this takes place with a certain associa-
tion of ideas and impressions. The subject talks with much ani-
mation, almost with furious energy, and seems astonished that his
listeners do not share with him his enthusiasm ; he is angry at the
slowness of their perception. In vain he tries to explain to them
his sensations : his own power of speech is too slow for him and
his ideas, whether exalted or sad, proud or humble, generous or
base, are always exaggerated. A true hypertrophy of ideas takes
place in a subject in this condition."
An ordinary annoyance grows into a poignant grief, the individ-
ual weeping over his unlucky fate. The simplest things of life
acquire an extreme dramatic significance, and simple remarks,
such as ''it is late" or "the wind blows" are made in most dramatic
tones of voice. The laughter is just as immoderate and dispropor-
tionate as is the crying, one phase merging into the other almost
without any transition period. At this stage the sense of fear of
ridicule attains its height, the subject watching eagerly the finest
quiver of his listener's lips, on the alert lookout for anything indi-
cative of mockery ; at the same time, the subject has a most exalted
idea of his own superiority of intellect and keeps on mocking at his
friends' ignorance (2, 3).
I shall now consider delirii caused by some other poisons.
COFFEE may give rise to a variety of delirium analogous to
that seen in delirium tremens. In the delirium caused by coffee
there is almost always present some physical element that plays a
part in the disturbance (anxia precordialis, apncea, exaggerated
heart beats, etc.), which is caused by the abuse of coffee.
THE LEAVES OF COCA AND THE COCAINE SALTS
also cause a marked delirium. Anrep demonstrated this by experi-
ments on animals. Soon after the injection of the poison the ani-
mal appears frightened, it trembles, and every noise produced
within its hearing causes it to suffer acute fright. After this
period, the psychic scene is changed — the fright is replaced by a
condition characterized by playfulness and feverish exaltation,
the scene closing with a profound sleep of several hours' duration.
According to Mantegazza, cocoa produces only an exaggerated
activity in ideation and speech; the effect varies, however, with
every individual. Richet, for instance, has not noticed symptoms
other than a slight degree of insomnia, after the injestion of a
moderate amount of cocoa leaves.
ATROPINE has, in its turn, its individual characteristics in
bringing about psychopathic phenomena. Most frequently, it
causes a delirium analogous to that induced by the action of alco-
NATURE OF DELUSIONS.— Dr. Ferrari.
117
hol ; there are spells of furor which end in uncontrollable laughter.
This accounts, perhaps, for the names given to the plant — (solati-
um, folatrum, maniacum, furiosum, etc.) The mydriasis caused
by the atropine often acts as a cause of intense and persistent hallu-
cinations.
To sum up what has been said regarding the action of drugs on
the central nervous system : there is a more or less marked and pro-
longed mental disgregation, which is due either to an excitation of
the mechanism of ideation, or of association of ideas, or to a lack of
inhibition.
DELUSIONAL IDEAS CAUSED BY FEVER.— Before go-
ing into any details concerning this subject I wish to remark that
the delirium which occurs during the course of acute fevers be-
speaks a predisposition on the part of the subject so affected; the
fever, the insomnia, anaemia and inanition — are all so many excit-
ing causes acting on a favorable soil and helping produce exhaus-
tion of the nervous system and the subsequent delirium.
Emminghaus(4), Wiedermeister(5), Mendel (6), Marandon de
Monthyel(7), Barrier and Ballet (8) have supposed and even ad-
mitted that under certain circumstances there existed a direct rela-
tion between the form of fever and the corresponding delirium
which was caused by it. Richet(9) affirms, with more cautious
prudence, that it might be said, at least, that certain psychopathic
symptoms appear to be more prevalent in some fevers than in
others ; he is inclined to believe, nevertheless, that the nature of the
delirium is determined by the toxines of the respective infections.
Silvagni(io) examined ten cases of various forms of febrile in-
fection in connection with the delirii which were manifested; he
concluded that, at all events, it might be accepted as a fact that
where there is an excessive production of toxic material in the
system, the predominating ideas during the course of the delirium
are those of being poisoned. It must be remarked, however, that
in those cases one had to deal with delirious ideas, but not true
delirium, and besides, those persons were more or less predisposed
hereditarily.
DELIRIOUS IDEAS OF THE INSANE.— First of all, the
remarkable feature here is the absence of variety of the ideas.
Morselli divides the delusional ideas of the insane into ten groups;
ideas of perplexity and vague proccupations represent those
groups, which might be classified as follows : personal humiliation
and degradation, remorse, physical alteration of the personality,
persecution, ideas of grandeur, mystic ideas, expressed by erotic
and impulsive ideas, and those of negation.
I shall not stop to make an analysis of the various forms of the
Il8 NATURE OF DELUSIONS.— Dr. Ferrari.
delusions mentioned; I shall rather consider their formation, and
then the mechanism by which they master the subject, once these
ideas are formed.
Morbid as well as delusional ideas take place in the same man-
ner as do normal ideas, when there exists an imperfect mode of
adaption of the internal to the external life of the subject. So long
as the subject's act harmonizes with the stimulus that gave it birth,
no false reasoning takes place, because there is no cause for its
existing. The cause that brings about sickly reasoning springs up
when there is some interference with the individual's adaptation
to his surroundings. This simple step in the genesis of morbid
ideation could well be followed in the initial stages of the develop-
ment of religions, science, industries and other developmental
branches which characterize social progress. They all go through
similar stages of development, faltering here and there, according
to the characteristics of the subjective and collective cerebration of
the society which undertakes the step of renouncing what was or is
for what should be.
The development of delusional ideas of the insane goes through
a similar scale of evolution, unlike the delusional ideas caused arti-
ficially by means of various drugs, intoxicants or toxines of or-
ganic or infectious nature.
The delusional ideas of the insane take birth ab intra and cor-
respond to a certain logical reasoning of the individual who is thus
affected. Contrary to what is observed in opium or hashish poison-
ing, for instance, we find that here there is no scintillation of ex-
pressed mental images ; nor is there either the variability or the
instability of conceptions observed during the course of delirium of
infection. Here, on the contrary, there is a certain number of
fixed ideas, always the same, regardless of the individual under
consideration; the only difference that may be observed between
these ideals of various individuals depends entirely on the differ-
ence of individual culture. Otherwise they are always alike, or, at
least, they follow their courses of development in exactly the same
manner in the same individual ; besides, these ideas are of marked
emotional nature, because they are expressive of the emotional side
of the individual's personality.
These ideas are identically distinguishable in all subjects, be-
cause they depend in all on a modified and altered power of men-
talization. As the mentalization represents the personality, the
former cannot be changed without inducing marked modifications
of the conscious "/."
The well balanced person differs from the insane subject in be-
in g able to check an erroneous flow of thought by sound mental
NATURE OF DELUSIONS.— Dr. Ferrari.
119
orientation. The insane, on the contrary, instead of checking the
mental error, are rather spurred on in their erroneous mental flight,
without seeking for the proper explanation of perplexing facts
which exist in their imagination only.
Schuele's explanation of the development of delusional ideas co-
incides with the results of my own researches on this subject,
which I have made at the Psychopathic Institute at Reggio Emilia.
Schuele says : "The perplexed / leans on the actual explicative
perceptions, bending them to suit those for which he is searching.
Under these circumstances, the patient falls under the influence of
his hypersesthetic attention, drawing distinct and intense percep-
tions from his vague and obscure ideas ; and no sooner is the delu-
sional construction under way than he reaches out for every fact,
recent or old, that falls within his knowledge, contaminating it
with a delusional and special significance to suit his primary con-
ception."
The psychiatrist, who is in daily contact with the insane, is
struck by the fundamental difference between the delusions of
auto-intoxication or infection and those found in the insane.
In the infections, the impure, infected blood which circulates in
the brain, gives rise to a number of mental images and ideas which,
while spurring on one another, are unsystematized. In the insane,
on the contrary, although there, too, there may be infected blood
circulating in the brain, the effect produced is totally different; in
this case the ideas are systematized, in unison with the fundamental
tendencies of the individual and they dominate him as long as they
exist.
The fundamental difference between the delusional ideas of the
insane and those due to extraneous causes is as follows : in the in-
sane the ideas always have an intimate bearing on the personality
itself. That personality may be depressed, exalted, or tortured by
them, but they always bear the imprint of the personality. This fact
is explained by the reason that the cause which brings about these
morbid changes does not come from outside, as is the case in in-
stances of fevers, intoxications, etc. ; here, on the contrary, these
ideas are the products of the brain itself; consequently the delu-
sions here spring from the organic, undifferentiated basis of the in-
dividual.
This principle is applicable to systematized delusional ideas as
well as to simple ones. I think that I have made this point clear in
a contribution published in the Rivista Sperimentale di Frenia-
tria (n); although this demonstration seems theoretical at first
sight, it is, nevertheless, highly practical. I have shown there that
the affective life is similar in the normal and in the insane subjects
120 NATURE OF DELUSIONS.— Dr. Ferrari.
and that it is fundamentally wrong to interpret the disordered cere-
bration of the insane as being of a primitive origin, as it is in the
paranoiac. So long as we persist in being guided by the false
hypothesis just mentioned, so long will we find it difficult to delve
properly into the study of insanity.
If these cases have been considered erroneously up to the present
date, it was because they have been studied from the point of view
of the marked symptoms which they presented at the height of the
disease, instead of during the initial stages. From the standpoint
of prophylaxis this question becomes very important.
The structure of the delirii will remain incomprehensible so long
as the mental mechanism is confounded with the old theory of as-
sociation ; the question becames more lucid, however, when we
think of our ideas and mental images as being living units, and, ac-
cording to the eminent American psychologist, units that exist and
act individually.
The systematized delusions of the paranoiac are exactly analo-
gous, in their construction, to the subconscious mentalization of
the hysterical subject; Breuer and Freud explain this matter satis-
factorily : in such patients the ideation has the imprint of the sub-
conscious, and the patient, therefore, is unable to correct his men-
tal course or apply to himself mental criticism. It is evident that
the physician should have control over such cases from the earliest
date when the disorder is noticed.
For the present, there exists a great deal of prejudice against
consulting a physician when the disorder encroaches on the affec-
tive side of life. A mental disorder is given its legitimate chance of
being cured, by an early consultation of a psychiatrist; but the
public has yet to be educated in the matter of equal urgency in
cases of affective disturbances. It is to be hoped that a proper
understanding of the duty in such cases will soon be reached, and
that these cases, the most important for early consideration, will be
afforded the proper opportunity to receive such aid as the science
of psychiatry has at its disposal to-day.
REFERENCES.
i. DE QUINCY. Confessions of an opium eater, being an extract from
Mental Science, p. 490, 1883.
2. RICHET. L'Homme et Intelligence, p. 123. Alcan, 1884, Paris.
3. BAUDELAIRE. Les paradis artificiels, p. 171. Paris, 1881. Al-
though the work is not technically scientific, the precision of facts described
here is most valuable.
VILLARD. These inaugurale, 1872, Paris.
GIRARD. L'art de faire les effets de Thaschisch. Encephale. I, p. 418.
DAVIDSON. Influence of hashish on mental diseases. Journal of
Menial Science, p. 490, 1883.
NATURE OF DELUSIONS.— Dr. Ferrari. 121
4. EMMINGHAUS. Arch. d. Heilk., H. 3-4, 1873.
5. WIEDERMEISTER. Cited by Seppilli and Meragliano. Arch. Ital.
p. I. Malattie Nervose, p. 248, 1878.
6. MENDEL. Cited by Silvaqui. Rivista Critica di Clinica Medica,
No. 38-40, 1900.
7. Marandon de Monthyel. Annates Medico-Psychologiques, 1883.
8. BARRIER, BALLET. Soc. Med. des Hopit. de Paris, 1890.
9. RICHET. Delire. In the Dictionnaire de Physiologie.
10. SILVAGNI. Op. cit.
11. G. C. FERRARI. Influenza degli stati emotivi sulla genesi e sullo
sviluppo di alcime psicosi. Reggio Emilia, Maggid, 1901.
POLITICAL ASSASSINS; ARE THEY ALL
INSANE ?
BY E. C. SPITZKA, M. D., OF NEW YORK.
{Concluded.)
In classifying the assassins generally according to the success or
failure of their immediate object, I am constrained to establish
a separate category for those whose purpose was accomplished by
random destruction, without reference to any particular person;
though the methods employed, the risks run, the terrorist aim and
the characters and associations of the contrivers affiliated them
to regenticides strictly so-termed. Like them these have pro-
voked special legislation and necessitated special governmental
vigilance. The Barcelona assassins, the Parisians Ravachol, Emile
Henry, and Vaillant, and the " Invincible' ' Barrett — all executed
after having imperilled lives by means of bombs or gun-powder,
belong to this "pan-cidal" category, which I have designated "O."
An apparent discrepancy in the tables, is explained by the fact that
in some, the estimate is made on a basis of the total of plots, in
others on the total of actors in the same plots. Both are required,
as the destinies of the actors in one and the same plot were not
always accomplished in the same way.*
*For example of the conspirators in the murder of Gustav III., Ankas-
trom was executed, Lilienhorn and Pecklin banished. Ribbing and Horn
fled and Bijelka committed suicide.
122 POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
The number given as insane in several of the foregoing tables
does not represent their actual proportion, but merely those assas-
sins whose disorder was recognized and who were treated as insane
by courts and juries. Among the executed, three at least, were
of unquestionably unsound mind ; that is, insane in a form so rec-
ognizable, that no physician of experience in charge of an asylum
for the mentally unsound would have hesitated a moment to receive
like patients ; but would certainly have hesitated to discharge any
one of them, after they had been placed under his care. The first
is the case of Bellingham. Here the mistakes seem to have been
rather errors of omission on the part of the defense perhaps due
to the hampering effect of a now obsolete system of legal practice.
The second is the case of Guiteau, whose conviction required a
more extensive apparatus, and where acts of commission meriting
a stronger name than "errors" were deemed necessary to secure the
punishment of a lunatic, whose insanity was notorious at the time
of and long before the assassination of President Garfield. The
third case in which errors of omission and of commission were
combined into a monstrous mistrial, a very monument of medico-
legal malpractice, was that of Prendergast the assassin of the
mayor of Chicago, Harrison. The termination of this case still
seems like an enigmatical dream.
The ratio of aggregate suicides and insane, among 277 persons
involved in the crime considered, is not quite one-fifth (19.13) ; of
insane alone, less than one-seventh (13.71), and of suicides alone
slightly over 6 per cent. (6.13). It should be borne in mind that
1 have here retained several cases of what Regis calls false regi-
cide ; among them two he specially mentions and whose records I
am indebted to his paper for. The motives of the insane are
sometimes so curiously contradicted in the execution of their acts
that I have not thought it proper to discriminate between this or
that one according to the inclination of his pistol when he fired.
If the bullet had struck a prominent personage it would doubtless
have been regarded as a regicide's missile ; and if the discharge of
a blank cartridge were to inflict serious damage the using such
would scarcely be regarded as a mitigating circumstance.
At all events, by including these items, the chance of any invid-
ious distinction is avoided ; for, if there be an error herein, it is
in favor of the position which I take different ground from.
The preponderance of Paranoia among insane regicides might
be presumed a priori. The formation of a deliberate purpose like
the premeditation of the means to carry it into execution, presup-
poses a power of systematized thought, perverted though it be.
Equally does the entertainment of a pertinent delusion or the con-
POLITICAL ASSASSINS.— Dr. E. C. Spitzka. 123
struction of a morbid project presuppose the same power of con-
secutiveness. One might class these regicides crudely according to
the two more frequent lines their dreams take: one a depressed
form, wherein the patient is the central figure of a conspiracy and
unjust treatment directed against himself ; the other an expansive
one, in which as the purifier, the reformer, the Messiah, he is
again the center around which all revolves, and on which all de-
pends.
If definitions were necessary each of these two classes would
require a particular one inapplicable to the other in this direction
at least.
It is the expansive form which more nearly approaches what I
shall venture to call, functional exaggerations within normal lim-
its, represented by lunatics of the Ravaillac class. As those re-
flect some dominant idea or tendency of their day in hypertrophy,
the insane analogue presents a reflection both monstrous antl
distorted. Usually regicide propensities when likely to develop in
members of this family are intercepted before their development
into sources of public danger, through early collisions with law or
with public prejudice. When their mission first moved them to
prophecy, to proclaim against or to enjoin a wicked and unappre-
ciative community or a narrow and overbearing magistracy, the
stocks, the pillory, the galleys and sometimes asylums were pro-
vided for their cure — and in more primitive times, more effectual
if less ceremonious remedies were doubtless employed. The his-
tory of not a few insane regicides is that their disorder had been
previously recognized, as was the case with Sefeloge, Guiteau, and
— as interestingly related by Regis — "Migelli." The failure to
carry out Dr. Reed's suggestion in the second, the premature dis-
charge in the last-named instance were responsible for the death
of Garfield and the dangerous assault on Deputy Feraud ; as neg-
lect to heed the timely warnings in Sefeloge's case led to the
wounding all but fatally of the Prussian king.
If the "false regicides" counted in the table were to be consid-
ered also from a clinical point of view as included, the contributing
clinical forms would be numerous, and might comprise practically
the entire domain with the exception of atonic melancholia, stupor-
ous insanity and the deepest grades of congenital and acquired de-
fects. Even epileptic insanity may thus be made to figure in the
series.
While it were not impossible for other forms, like paretic de-
mentia in its initial phases, to lead the patient to contemplate
and — extremely rarely — attempt regenticide, traditionally so re-
garded, the psychosis typical with the insane actors is paranoia;
124
POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
and of all its forms the most frequent in turn paranoia originaria.
It is in the gradual transition of this condition through the "insane
temperament" and "borderland" into sanity that the exceptional
doubts of the legitimate alienist have their source.
Since the occurrence of suicide has been mentioned in relation,
some data thereto relating may not be amiss.
Among those enumerated as suicides three, Norcross, Ryssakow
and J were killed by their own explosives under circum-
stances which render it beyond question that the act was one of
premeditated self-immolation.* Marcellus, the Byzantine, killed
himself like Dymnus on the detection of a plot, with, as it proved,
wise foresight from an ancient's point of view, for his associate,
Sergius, was tortured and executed ; Paris did so when his arrest
was declared, Brutus and Cassius without awaiting that event.
Blind, after wounding Bismarck, committed suicide in jail the
evening of the same day. Sperandio killed himself after shooting
his victim dead; Nobiling, after wounding the old Emperor
William dangerously; and most recently a Nihilist after missing
the Czar. Ortiz did the like on finding escape impossible, having
shot at and wounded President Santos ; and Bresci destroyed him-
self after having entered on his life-long term of imprisonment.
Mrs. Justice, one of the Clerkenwell conspirators, made an attempt
at suicide; as also did Pietrucci and deBurgal, the latter success-
fully, on finding their plots discovered and themselves arrested;
Epicharis, in an interval of her torture, dashed her head against a
wall and died Strozzi-like, rather than betray the other members of
the anti-Neronic assassination plot, in connection with which, Libo
also committed suicide at another place. In Norcross' and J 's
cases alone can I find reliable records or evidences pointing to men-
tal disease.
Among the noteworthy features of these tables is the contrast
between the relative success with which steel and firearms are em-
ployed by the two classes. It seems that the more determined and
courageous an assassin of one class ; and in another class, the more
physically brutal, the more likely is the former to be employed.
Clement, Ravaillac, Felton, Anviti's, Rossi's and Rumpf 's and the
*Only the agency of their own hands was lacking to technically constitute
the assassination committed by several in the series, who were instantly
dispatched, as associated suicidal act. The assassins of Alp Arslan and
Amurath in the midst of the respective armies of their victims had not the
slightest prospect of escaping such a consequence of their deed, and vir-
tually were suicides. The same might be claimed in other like cases. The
ending of their own lives was the main motive in the case of one insane
and an initial one in that of a sane regenticide, Hadfield and Ladmiral re-
spectively. These are not enumerated as suicides in the tables.
POLITICAL ASSASSINS.— Dr. E. C. Spitzka. 125
Duke of Parma's assassins, Corday, Louvel, Paris, Sand, Suley-
man, Casario, Luchini and the Invincibles of the Phoenix Park
tragedy, the latter three appertaining to the second class, show that
with the gradual crowding out of steel as a weapon of war by
firearms, it has by no means been correspondingly eliminated from
the regicide's armamentarium. Indeed it is more successfully
employed in the ratio of 3 to 2 than are firearms.
But with the insane it is different ; the steel has failed them in
every instance.* Whether it was an insane Merino priest, assailing
a Spanish Queen, or Margaret Nicholson, the claimant of George
I IPs throne, in most cases either no injury or mere scratches were
inflicted, whereas with firearms the percentage of success was prac-
tically equal. The aim of Bellingham, McNaughton, Miller,
Guiteau, Vera Gelo, Prendergast and the assailant of Archbishop
Sibour was as deadly as that of Ankerstrom, Poltrot, Gerard,
Czolgosz and the assassin of Governor Goebel ; and of the fifteen
who failed to kill, Arnold, Renshaw and Sefeloge inflicted serious
injuries.
A -second suggestive feature is that the use of such primitive
missiles as stones and the like is confined to the insane exclusively.
Frith and Collins of England, Schnapka and Weiland of Germany,
being the instances.
While there are forms of insanity with which the highest degree
of physical courage, firmest determination and fiercest purpose are
by no means incompatible, yet such forms seem but exceptionally
to lead the patient in the direction of regicide. As a rule the
regicidal lunatic is not like Hadfield of a class which would enjoy
the "imminent deadly breach," the revolver he more frequently em-
ploys is selected, because its use involves physical strength and
courage least of all weapons of fatal potentiality. The revolver may
prove as fatal in the hands of the coward as the hero's, the weak-
ling's as of the athlete's ; it may even succeed in the hands of him
who, like Guiteau, is frightened "almost to death" at the report of
the "first shot fired in his life."
As a rule we do not find the stamina manifested in the firm, sure-
aimed and well calculated dagger-thrust of a Corday among the
qualities of the insane regenticide — as to the Degenerate, when
the proclaimers of degeneracy dogmas shall have formulated what
is not Degeneracy, it will be time to calculate its influence on this
or other elements of the regicide mentality. At the present day to
do so would be tantamount to an analysis of the human mind in
general; for degeneracy, as alleged by some, practically includes
our soecies as a whole.
:In this century and the two last ; Ravaillac succeeded in an earlier day.
I26 POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
The contrivers of mechanical devices in connection with mines
and timing the explosion of bombs are more likely to number
amongst them an insane comrade in the way of a project-fertile
paranoiac inventor. Such a one, however, usually leaves the
actual consummation of the fatal purpose to other hands, albeit, his
legal responsibility is not thereby abated a jot from the status of a
principal assassin.*
It is notable that in the small body of female regenticides, the
relative proportion of the insane is much greater than among
males. Something similar is found in certain tables relating "to
ordinary homicides. The influence of mental disease in giving rein
to those propensities which are ordinarily held in check through
modesty, diffidence and other attributes of normal and average
femininity, may be supposed greater in case of regenticide than of
ordinary murder. For as the former involves in addition to the
factors of simple homicide the liberating from all those checks
which are operative against emancipation, it, relatively speaking,
enlarges the recruiting ground of those fitted to dare the publicity
regenticide involves.
A corresponding relation appears to exist generally between the
number of regenticides and the degree of emancipation attained by
the female in particular countries and classes of society. Its max-
imum is among the female students of Russian universities, and
associated circles. Here we have the Gelos, Peroskajas, Sas-
suliches, Kalnuschnayas, and such. Few, if any, of the celebrated
plots in Russia but had one or more female accessories or even
principals. A large number is also found in France ; the contribu-
tion of this land appears more considerable inasmuch as a longer
period of emancipation furnishes the quota; for the same period
of time it is really less than in Russia. France** contributes Cor-
day, Migelli, Renault, Encore, Mignon, Leon (Gambetta's as-
sassin), and the would-be assassin of Alfons Karr; England,
Justice,f Nicholson and Yseult Dudley; J United States, Neil;
♦About none of the individuals in the series, from which the statistics
here given are derived, have I had such misgivings as to his proper place,
as concerning Kibaltschitsch, the maker of the bombs thrown by Ryssakow
with such fatal effect to a former Russian Czar. The data are imperfect.
Among other facts it is mentioned that in prison and up to the time of his
execution, Kibaltschitsch was busy with models of inventions,
** The would be assassin of Professor Deschanin, Vera Gelo, was, I
infer, of Russian origin. <"
fCame from the United States.
^Committed her crime in the United States, coming from Wales for
the purpose. Her intended victim was a Fenian agitator, who had then been
particularly active in urging on the terrorist outrages.
POLITICAL ASSASSINS.— Dr. E. C. Spitzka. 127
Germany, Schnapka. Of the Russian female assassins, one of six ;
of the French, three of eight; of the English, two of three,
and in the American and German single cases, each was in-
sane.*
The female ratio appears to reach the maximum at the time of
the decline of Rome and the Merovingian reigns. From Messalina
to Rosamonde and Agrippina to Amalasuintha a gradual trans-
fer of assassin arts from the civilized Roman to the Barbarian im-
migrant can be traced; and as a later day saw the toxicological
science developed by the Borgias carried over the Alps to the
Brinvilliers coterie ; so the mantle of the Roman and Gothic stran-
gles and poisoners, taking the same way, found worthy shoulders
among the Merovingian and Burgundian Queens. Nor must we
imagine the Barbarian soil unprepared for such corrupting seed,
as the Utopian sketch of Tacitus would have us believe, for the
chieftain, Abegandestrius,f is mentioned as having requested
poison from Rome wherewith to experiment on the destroyer of
those legions, for whose restoration Caesar Augustus implored the
shades of Varus vainly. Whenever the activity of the transalpine
assassins flagged, another influx from Italy as in the day of a
Medicaean Catherine would infuse renewed activity and start a
new school. From suoh a one, Scotland received the contrivers of
the pioneer explosion-assassination of Britain, that of the "Kirk
o' Field;'' forerunner of the like scheme subsequently directed
against the son of Darnley and Darnley's assassin, and against that
Parliament destined to be attacked once more with the more dan-
gerous explosives of the nineteenth century, but as fruitlessly as
with the primitive one to which the "Gun-powder Plot" owes its
name. Thenceforth thrones ceased to furnish regicides ; from the
palace their crime passed to the cabinet where the hirelings of
Philip II and Louvois might receive their instructions and prom-
ises, seldom more than promises, of reward. Later the laboratory
of the regicide became degraded to the remoter country-seats or
dingy coffee houses ; later still, to the boarding-house or hay-loft ;
eventually, unable to sink deeper, it found its hatching places in the
hovels of misery, the editorial dens of revolutionary journals, and
other purlieus of rascality.
With this transition the part of the regicide seemed to have
become monopolized by the male sex ; till, with the French Revolu-
tion, the female magnicide again made her appearance — not in
*I assume that Theroigne de Mericourt and Rosa Lacombe are not reck-
oned as properly speaking magnicides.
t Perhaps, however, as "agent provocateur?"
I28 POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
the guise she presents at the present day, for her motives ap-
proached the justifiable more nearly than under most circumstances
connected with like offenders. With the disappearance of the rev-
olutionary monsters and return of peaceful times the female again
becomes absent from the annals of regenticide to reappear in our
generation in the repulsive form of a creature who belies as she
befouls the name of Woman ; the prompter behind the scene of the
dolt who carries out her malicious and purposeless design of
regenticide as his "duty." The linen wrapped around the hand
of Stephanus concealing the dagger to which the husband of
prompting Domitia was to succumb, in the more modern shape of
a handkerchief has played its part otherwise than as ambuscade
concealing the weapon to which McKinley owed his death : it was
Peroskaja's handkerchief that waved the signal for the casting of
that bomb, which, in mutilating death, ended the career of the
Emancipator of the Russian Serf.
In those to whom is laid bare the source of any social disease,
expectation of a suggested remedy is naturally aroused. The
panacea usually offered in the cases before us is either the Re-
formatory* or "Education." Like most specious solutions of sim-
ilar problems the latter suggestion reminds one of the strategy of
the Celt when in a quandary "answering a question by asking
another." The kind of education calculated to divert the mind
from a purpose so stupidly criminal as the murder of those in high
station or power merely because of that station or power held, may
prove difficult to determine, and again, to apply to those classes
from which the regenticide of the present day is chiefly derived.
So far is a prevalent kind of education from being antidotal to the
development of the ill-regulated, embittered or desperado dreamer
state of mind, which often underlies the regenticidal motive that
^Taking certain of our large cities, suppose we aggregate to the already
so classed insane, idiots and deaf-mutes, its politicians, gamblers, tramps,
habitual corner-loafers, chronic street missionaries, reformers, anarchists,
yellow journalists and criminals generally in an institution for degenerates
for purposes of restraint and (suppositious) treatment; drawing from the
remaining "standard" population the necessary staff of directors, physi-
cians, attendants, laborers, etc., what proportion would remain outside
the walls of such institution. If not deprived of their franchise, it were
conceivable that the institutional inmates in case of a "plebescite" might
reverse the respective positions of the "ins" and "outs!" As it is their
practical control of municipal government has been exemplified and more
than one sober citizen experienced passions and contemplated projects dif-
fering from those of the "magnicide" only in their application; showing
that such may be entertained by exceedingly well balanced minds and even
merit the approval of a majority of intrinsically good citizens.
POLITICAL ASSASSINS.— Dr. E. C. Spitzka. 129
the forcible term "Gelehrten-Proletariat"* was given by Bismarck
to the very class, from which demagogue adventurers, anarchist
editors and other restless political "ne'er-do-wells" are re-
cruited.
I do not regard even a special and well-directed educational plan
as an absolute prophylactic of this or of any other crime. The
practical question regarding the attainable, remains : what is best
calculated to germinate in the virgin soil of the youthful mind
that also as an object-lesson can be brought right before the eyes
of the one who has not strayed too far in the path which leads the
fanatic or the notoriety-seeker to his sinister end. Educational
charts hold out some promise to prove the efficacy in this direction
as they do in others. When I recall my own college experience
there are particularly vivid, certain reminiscences of charts from
which — and from no lesson or text-book, for these taught it not —
the order of geological strata, topographical profiles, mountain-
altitudes, decimal and other measures, racial types, and other faint
glimmerings of ethnology and archaeology were assimilated, — and
fairly well retained ; whereas, of certain parts of the official curri-
culum, the less said, the better — and the still less than less said of
what was not thereof retained, still better!
In the main the chart I have in view would inculcate its lesson
from a utilitarian standpoint. To base any instruction of the class
of minds it must be made applicable to, on altruistic grounds or on
abstract moral principles would result in as much worse than a
failure, as the crimes, which it were intended to prevent are worse
than purposeless. The selfish Ego can, however, be with some
prospect of success utilized as an indirect approach to the True
and Good, when the latter may be demonstrated as at least not
injurious and of relative benefit to the pupil in so far as deviation
from the correct path inevitably proves not alone disastrous to the
individual as well as to his cause but may actually benefit the cause
which is or which he regards as antagonistic. Certainly few series
of facts can be placed in such a striking array of unanimity of
evidence as those in the tabulated chart of which I present a section
as a specimen ; the whole being of seventy-two typical cases.f
* A class of university-educated persons with whom the absence of
worldly means is not made up for by transcendant talents nor by well-
directed industrious application ; in some respects not unlike a certain class
of place-hunters, professional men and literati, in our own land.
f The more striking cases, historically considered had been selected, other-
wise the chart would include practically all of several hundred, and abso-
lutely all of that smaller class in which single assassins acted, or a few
assassins cooperated, still numbering over a hundred.
100
POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
NAME, DEED AND
FATE OF AS-
SASSIN.
I. Charlotte Corday
(killed Marat). Exe-
cuted.
2. Paris. (Killed
Lepelletier St. Fargeau
Deputv for voting the
King's death.) Sui-
cide.
3. Ladmiral. (At-
tempt on Deputy Colot
d'Herbois). Executed.
4. Renault. (At-
tempt on Robespierre).
Executed.
5. Cambon, Limole-
on, St. Re j ant. (In-
fernal machine against
Bonaparte). Execut-
ed.
6. Cadoudal. (Con-
spiracy against Bona-
parte). Executed.
7. Louvel. (Killed
the Duke of Berri).
Executed.
8. Sand. (Killed
Kotzebue). Attempted
suicide and executed.
PURPOSE
OF ASSASSIN.
Salvation of Giron-
dist fugutives, preven-
tion of Marat's Pro-
scription.
Royalist cause, and
intimidation of the
"Mountain" Party.
Demonstra tion
against the Terrorists,
and own death.
Demonstr ation
against the "tyrant" in
behalf of Humanity.
To destroy the First
Consul.
Also to destroy the
First Consul.
To prevent the pro-
pagation of the Bour-
bon line, whose sole
channel of possible con-
tinuance rested in the
person of the victim.
To punish the libeller
of German students and
vindicate University
Freedom.
9. Agent of Jesuits.
(Attempt on King Jo-
seph II. of Portugal).
To interrupt an in-
quiry into their man-
agement in Brazil,
RESULT REALIZED
BY THE ASSASS-
IN'S ACT.
Girondists more
fiercely pursued and
destroyed. Reign of
Terror established ;
Marat almost deified.
Apotheosis of the
Martyr Lepelletier, the
Terrorists strength-
ened, and last remnants
of opposition silenced.
Colot, owed his life
on a subsequent occa-
sion to the wounds re-
ceived; he showed the
scars when threatened
bv a faction, and gained
time to escape.
Fortified Robespi-
erre's position who be-
came the object of he-
ro-worship; in fact, R.
wished the attack had
been more serious; he
envied Colot his "more
eloquent scars."
Strengthened Bona-
parte by furnishing
pretext for removal of
many who would have
proven obstacles to his
scheme of imperial
sway. Also killed
some unconcerned peo-
ple.
Discovery of the plot
furnished the pretext
for removing the last of
these obstacles, Mor-
eau, and the Empire es-
tablished the following
month.
The Bourbon line
propagated through a
posthumous male child
of the victim's.
Liberal professors
and students expelled,
others fled ; student-
societies dissolved, uni-
versities placed under
police- restraint.
Thought fettered, and
in the end it was found
that the wrong man had
been slain. The author
of the libel was Stourd-
za.
Expulsion of the Or-
der, not alone from the
colonies, but from Por-
POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
131
10. Charagites of
Kufa. (Killed Ali Ben
Ali Tahib). Killed (?)
11. Persian Baburs.
(Attempt on Nasr
Edin). Executed.
12. Unknown Assas-
sin of Papal legate
Castlenau. Remained
unknown.
13. Clement. (Killed
Henry III. Killed on
the spot.
14. Chastel. (Attempt
on Henrv IV.) Execut-
ed.
15. jJamiens. (At-
tempt on Louis XV.)
Executed.
16. Kullmann. (At-
tempt on Bismarck) .
Imprisoned.
which threatened their
prestiee in the Col-
onies
To destroy his inno-
vating influence on re-
ligion.
To check restraints
on their sect.
Ditto: cause of the
Albisrenses.
To avenge the Guise
party and vacate the
throne for the claimant
of that party, pledged to
destroy the Huguenots.
To strengthen the
Jesuit wing of the same
party.
In the same interest,
In behalf of the Cath-
olic or Ultramontane
party.
tugal itself as well
Their chief Malagrida
executed.
Developed and
spread it, the assassin-
ated's name becoming
the watchword of the
movement.
Sect exterminated
through bloody pro-
scription.
As above.
Throne filled by Hu-
guenot King Henry of
Navarre, Edict of Hu-
guenot toleration.
Jesuits expelled from
France.
Choiseul succeeded
in getting the lethargic
king to second efforts
bep-un the following
year, which ended in
their Order being dis-
solved in France.
Assisted more effici-
ently Bismarck's vic-
torious "Kulturkampf"
than any ally the latter
had.
Of instances in which a better man, even from the assassin's
standpoint, was killed, and place thereby made for a worse, the
annals are full. What became of Phillip's cabinet after the murder
by his agent Taurion of the former's great Corinthian adviser?
Wherein did Alexander III equal or approach Alexander II?
What constituted the superiority of Carnot's successor that would
justify the Italian's dagger, even from a Casario point of view?
How did the White Boys enjoy the change from Chief Justice
Lord Kilhaven to the one who next presided over the same court ?
Wherein did Rome gain in her transfer from Galba to Otho and
Vitellius? Who succeeded Probus and Pertinax? Was there a
possible "worse" of the two: Caracalla and his nothus Elegabalus?
For Macrinus merely stepped in and out betwixt the murder of the
first and the enthronement of the second. Did Amurath's death be-
fore the Amself eld battle turn the scale of victory from the Turks ?.
When, after destroying the Christian Army, the successor of the
Servian patriot's victim had the captured French nobles beheaded,
to whom did the latter really owe their death? Was not the
vindictive slaughter to avenge that "patriotic" poniard-thrust?
What ensured the accession of John the Spurious so much as the
132
POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
reaction caused in the public mind by the "dynastic legitimacy"
moved assassination of the former's mother ? What provoked the
bitter feeling that crushed the South under a notorious "Recon-
struction Policy ?" Methinks it was a bullet fired by a "Southern
sympathizer," killing him whose prolonged life the South later
knew it ought best have prayed for.
When the "Homestead Strike," of all labor-movements the best
as to merit and conduct, was on the eve of triumph, what turned
victory into defeat ? It was that an anarchist, not at all connected
with the strikers, suspected of being a spy, felt it imperatively
necessary to remove that suspicion by some overt act like assassin-
ation; and had selected as his victim the superintendent of the
works where the strikers were employed. This act against "the
tyranny of capital" simply crushed the self-helping laborers' cause,
although the deed was as unwarranted and unauthorized by these
and done by an outsider equally as was the bomb-throwing by the
Italians Pieri Rudio and Gomez ordered by their chief at the vesti-
bule of the Parisian Opera.
There is one class of assassins of public men for whom a posi-
tion in the chart would be difficult to establish ; inasmuch as con-
sistently with the title of their clan, the random acts of the soloists
in the Anarchy troupe are too remote from any of those ordinary
lines of human thought and action, to permit one's realizing any
motive and purpose either theoretically, practically, abstrusely or
concretely considered. Their murders cannot be attributed to a
mere destructive instinct ; it does not appear that a feeling embit-
tered by envy of the wealthy, jealousy of the successful or the
Marat-like one of hatred of wearers of clean linen ; in short, any-
thing that can be termed a motive, — no matter how despicable,
stupid and vicious it were but after all, a sort of motive — provokes
the assassin. Severally the last three of this sect to murder on our
side of the Atlantic used two phrases in justification of their deeds ;
the one assigned it to a sense of "duty," the other phrase defined ft
as : not murder of the individual slain, but as an attack on a certain
vicious principle the victim had represented. That the murderers,
one of whom is yet in jail, one dead by his own hand, and the third
by that of the law, were the authors of this last phrasej regard as
unlikely. The mind, originally molding the proposition quoted,
would naturally realize the complementary one, almost automati-
cally, namely: "if Mr. Anarchist kills Mr. McKinley, not as Mr.
McKinley but as the representative of a system called a vicious
one, the law will kill Mr. Anarchist, not as Mr. Anarchist, but as
an active and tangible incorporation of Anarchy — called by no
adjective, as "sufficient for qualification is the noun thereof."
POLITICAL ASSASSINS.— Dr. E. C. Spitzka. j^
The most efficient recruiting for Anarchy's rank and file is ac-
complished by speculative industrial combinations and the sudden
vicissitudes to which — in the way of "shutting-down" — they ex-
pose the man who is skilled, able and willing to work.
But amid the incongruities of Anarchy's principles and leading
personnel, which latter cannot plead the last mentioned provoca-
tion, one tangibility can be disentangled as the probable agent
which maintains the chaotic thing in its particular erratic orb. The
focus of fermenting, or inner circle of each group, includes with
almost uniform constancy these ingredients, of which the three of
subsidiary importance may in description precede the more initial
and essential one; for it is their united instrumentality through
which the fourth appears to operate.
1. The Inflammatory Orator: His earlier experience as a fail-
ure in the contest of existence of civilization, not alone has made
him imbibe a profound hatred of the latter ; it also furnished him
with such fragments of knowledge, badly annealed into a system
of sham logic, as amalgamated with his personal chagrin sustain
the fiery tirades he delivers from the beer barrel.
2. The Tactician : Usually an idling mechanic whose ambition-
prompted attempts to rise above his station failed, because not
seconded by that industry or ingenuity which a tyrannical "sys-
tem" makes a condition of promotion — at least in the department
of skilled labor. He has, through desultory reading, acquired some
knowledge of glycerine, nitric acid, picrates and fulminates gener-
ally; this, together with some reminiscent mechanical knack in
handling wire, glass and sand, enables him to prepare death-
dealing contrivances, as more speaking arguments of his creed,
than those of Number One.
3. The "banneret" and Jean d'Arc of the group. This person-
age's exterior is usually a true index of the inner woman, making
her influence alone explicable on the ground of the occasional con-
trariness of our species.*
4. Last comes the editor of the anarchist organ, whose title is
"Liberty," "Work" or the like; and whose motto is usually as
applicable to the principles of Anarchy as the time schedule in-
scribed on a banner at one of its "Union Square" demonstrations
is to the narrow-minded bourgeois limits of the actual number of
hours in the day :
*In the Chicago group of "Haymarket fame" the representative of the
third category departed from the Caucasian ideal, not only like her sisters,
morphologically; but also in color.
134 POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
"Eight Hours for Sleep !
Eight Hours for Work !
Eight Hours for Rest !
Eight Hours for Intellectual Improvement!
As to the epochal periodical, it does not employ a very large
staff of foreign correspondents; and as it consistently refuses to
avail itself of any "exclusive class" privileges, — such as paying
for news obtained by a capitalized syndicate, — enjoyed by hireling
journals, is constrained to await the appearance of the latter and
publish such news, twenty-four hours later. To compensate for
this short-coming, an overplus of spicing is had resort to. Tur-
bulent editorials are concocted with the aid of Number One, and
Number Two furnishes squibs anent heart-rending instances of
the chicanery of capitalists shown in utilizing the product of the
labor and skill of virtuous bread-winners, and passing it off as
their own ; or of such, feeding their employees on food, discarded
as too venerable by twenty- four hours at the general market. All
of this is as anarchical as may be ; and can be declared inconsistent
with the above indicated manner of obtaining and punctuality in
delivering the wares in which a newspaper deals, only by hide-
bound conservatives and by the "lick-spittlers" of our existing cor-
rupt legal and social system.
But even the strongest editorial spicing cannot always make up
for a deficient pabulum ; and since collections of moneys are being
taken up, through the editor's unselfish instrumentality, of course,
in behalf of "martyrs," "victims," "explosive materials," "skir-
mishing funds" or the "Cause" and "Brotherhood" generally,
something real, — the more sensational, the better, — must be done,
and from time to time repeated, to keep the subscriber's fever heat
at that continuous level, essential to the editor's continued exist-
ence, such as it is — spider-like, some may call it! Now imagine
among the worshippers at the shrine, one who joins to the imma-
turity of youth, the enthusiasm of the novice; to which becomes
added the kind of stimulus this establishment is so well calculated
to supply ! Of translation of empty phrases into substantial deeds,
does he not see the very example concretely before him? Other
journals — or rather the staffs of such — are content with preaching
theories ! Here he beholds the union of proclamation and visible
labor into the propaganda of the bomb! Spell-bound in hero-
worship, ambition and fervor on his own part ; magnetized by the
flattery of the sturdy engineer ; inspired by the denunciations of the
orator ; and instructed in the use of handkerchief ambuscades by
the "Jean d'Arc," he is prepared to do the act that shall "vibrate
POLITICAL ASSASSINS.— Dr. E. C. Spitzka. . 135
through a world, shake its collective tyrants on their thrones and,
reverberating through ages, echo his name to a grateful posterity."
The extra editions of the "Workingman's Arms," "The Fire-
brand," "The Hammer of Liberty," "Bread or Blood," or whatever
name the particular editor's "staff of life" bears, need not be men-
tioned at the time of ordaining the self-immolating Apostle of
Action !
As to the application of restrictive measures at this fountain-
head of regicide — not far from being regicide in another sense:
since, beyond the crowned Majesties, the Majesty of the People
seems threatened, — it is not my province to discuss the relative
merits of two alternatives which naturally present themselves. One
is the pensioning of the aforesaid Number Four ; — the other three
being harmless without the head, and hence not requiring special
provision. This would deprive him of any temptation to work
damage which is inseparable from industry limited to any sphere
which is his. The other would involve an infringement on — to
call it liberty were worse than irony — the license of the press. I
hence content myself with pointing out the marrow of this, alterna-
tively, Medusa and Hydra-headed monstrosity — where it seems, to
me, to be located.
In this relation a second lesson to be drawn from an inspection
of the chart mentioned promises to prove perhaps more valuably
efficient than the original one intended and render the "pensioning"
superfluous. As it's mere converse and hence, within the grasp of
the simplest intelligence, it is not necessary for me to more than
mention it, and point out its presumptive sphere of greatest use-
fulness. If, as the chart teaches, the assassination of leaders of
an opposition be so useful to that opposition as to react injuriously
to the assassin's party, it follows that his tactics must be reversed ;
it being desirable to create martyrs useful as such to one's own
side, on that very side and not on the other. Now, inasmuch as
human lives are not to be considered when the "Great Cause" of
Anarchism (or whatever "ism" it may be) is at stake, let its most
disinterested and courageous exponent scatter a half-dozen bombs
or so, with the necessary initial velocity — not at a Barcelona thea-
ter, killing aristocrats and being garrotted for it six at a time, —
but at a meeting of Anarchists ; the more crowded, the better ;
clearing the atmosphere besides furnishing grounds for a flaming
screed entitled "More Capitalistic Outrages!" "Bourgeois As-
sassins !" "Our Thunder Stolen !" Should this not prove quite as
drastic as the "Cause" demands, a revolver placed in judiciously
calculated proximity to the incorporation of anarchical journalism,
the Number Four aforesaid, might be made to speak more ef-
I35 POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
fectively than the perforatee ever wrote. The ensuing obituary
sermon would furnish Number One with a fresh opportunity,
Number Two would learn where to place his contrivances so as to
do the most good — not necessarily moving out of the way himself
— and Number Three could change her traditional costume of fiery
red for a more becoming black, and the role of Jean d'Arc for that
of Medea.
The lingering suspicion is apt to haunt one that the various
"Number Fours" active in their field may not take to this idea with
that unselfish unanimity earnest devotees of their cause have some
reason to expect. Else they would publish this chart, give it the
widest circulation and supply the new subscribers, ambitious of
magnicidal distinction, with an extra and clearly legible copy.
In an historical sketch of regicide I had occasion to refer to the
transition from higher to lower classes in the personnel, the
changes that have taken place in the outward guise and to some
extent the intrinsic nature of the impellent motive; here I shall
briefly direct attention to two other conditions, one closely related,
the other analogous to the former.
Motives dependent upon momentary causes, mortified feelings,
disappointed expectations, direct personal oppressions, insult to or
injury to close friends, predominated in ancient times ; and the de-
struction of the hated superior was accompanied by all the elements
of the theatrical tragedy, in the visible rush of the arbiter of fate
in the fateful blow and the equally sudden annihilation of the de-
stroyer. While in the lands foremost in progress the personnel,
the instruments and motives have like other matters become more
prosaic, the lingering of the old with less advanced nations is as
marked in this as in less tragical fields of human action. A few
years ago one Hassan, a Circassian officer, rushed into a council of
the Turkish ministry to avenge his chief, the deposed Abdul Asiz ;
before he could be overpowered he had killed two of the Ministers,
among them Hussein Awni Pascha. As if to complete this atavistic
record, that class of assassinations, which we had long supposed a
relic of the Past the murder of sovereigns by a Camarilla, was re-
enacted by Midhat Pascha and on the very Sultan to avenge whose
dethronement the Circassian had enacted the magnicide reminis-
cent of Pausanias. Like this latter did the Mingrelian Dadeshka-
lian poinard a ussian Governor-General Gagarin ; and Cadich
avenge his banishment on Danilo of Montenegro.
Even in civilized lands an occasional lapse of virtue on the part
of a high-born lady led her to follow the example of her mediaeval
predecessor in the same predicament, driven by the same despair ;
namely, the assassination of the living evidence of her indiscretion.
POLITICAL ASSASSINS.— Dr. E. C. Spitzka. 137
It is the opinion of many, as it was that of the distinguished Jurist
Feuerbach, that Caspar Hauser the mysterious waif was assassin-
ated from this motive.
But on the whole this crime has descended from high places,
and its tendency to select its actors from lower and lower classes,
observable from epoch to epoch, is accompanied by a still more
hopeful change, the decreasing proportion of sane regenticides.
This decrease is not exclusively inferred from the observable
lesser frequency of regentical acts committed by the insane as we
trace the history of the subject retrospectively. A stronger sup-
port is furnished by the comparison of the respective ratios in
countries advanced to different grades of attainable perfection in
civilization and governmental forms. It is found that in the states
most advanced in these respects, the proportion of insane actors
has become so large, that in the present half century, two countries
of Anglo-Saxon origin may boast that half those resorting to the
most hurtful and most stupid of crimes are of unsound mind ; while
in the lands most backward, a ratio of under ten, and even six per
cent, is found. Nor is it the mere approach to or existence of a
Republic that seems to be the factor here, for there are republics in
the same part of the world, where assassination is rife and neither
the public suspect, nor do the events show insanity in any single
case ; it is a question of race and the civilization of that race most
largely.
There is, then, this hope intertwined with the prospect of future
advance : that the contemplation of this crime may eventually be-
come the monopoly of the lunatic. When that day shall have
come, the interpreters and executors of law, our own profession
and the people at large will doubtless have united on a policy of
timely care of the mental invalids for the latter's own protection,
as well as for the protection of society. In that day, regenticide,
through the sequestration of its then only possible source, no
longer a danger, may, as a reminiscence of the Past, serve to adorn
some tale of the "good old days of yore."
MORTALITY
MORTALITY IN IN RELATION
RELATION TO TO NUMBER
THE NUMBER OF PERSONS
OF ATTEMPTS. ASSAULTED.
Monarchs and Heads of Governments of the
United States and France 15.4 per cent. 25.4 per cent.
Cabinet Ministers 45.0 50.0 "
Presidents of Republics* ranking as Second
and Third-rate Powers 60.0 62.5
Police and Higher Officials 65.0 65.0
Petty Sovereigns and Princes 71.4 76.9
Military Officers 81.8 " 81.8
Higher Sacerdotal Officials. . . . , 85.87 " 85.87
138 POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
WEAPONS EMPLOYED IN 117 CASES BY ASSASSINS OF
SOUND MIND.
SUCCEEDED.
Firearms 19
Steel weapons 21
Explosives 3
Stones and other missiles o
Total 43 64 117 36.75
RATIO OF
FAILED.
TOTAL.
SUCCESS.
31
6l
31.14
22
43
48.76
II
14
21.42
O
O
WEAPONS AS EMPLOYED IN 33 CASES BY ASSASSINS OF
UNSOUND MIND.
SUCCEEDED.
Firearms 7
Steel weapons o
Explosives 1
Missiles of metal and stone o
Total 8 25 33 24.24
RATIO OF
FAILED.
TOTAL.
SUCCESS.
15
22
3I.8I
5
5
....
1
2
5O.O0
4
4
TABLE SHOWING THE NUMBER OF INSANE AND SUICIDES
AMONG ASSASSINS, AND THE SUCCESS OR FAILURE
OF THEIR HOMICIDAL ATTEMPTS.
(A.) — INSANE. MALE.
Succeeded in killing person aimed at 8
Wounded ditto 6
Killed exclusively persons not aimed at 1
Failed to inflict any injury 17
Total 32
(B.) — SUICIDES.
Succeeded in killing person aimed at** 8
Wounded ditto 5
Killed exclusively persons not aimed at o
Failed to inflict any injury 2
FEMALE.
TOTAL.
I
9
I
7
O
I
4
21
6
38
0
8
0
5
1
1
1
3
Total 15 2 17
Total aggregate of Insane and Suicides 45 8 53
** Two appear in both tables, and should be deducted from the aggregate.
SANE. INSANE. TOTAL.
M. F. T. M. F. T. M. F. T.
Successful assassins not
protected nor using
surreptitious methods
like poison 77 3 80 6 1 7 83 4 87
Ditto: did not succeed in
realizing assault 25 1 26 25 1 26
Realized attack but only
wounded or failed alto-
gether 68 5 73 21 5 26 89 10 99
(Of these latter wound- , N t v , rtv
ed) (18) (1) (19) (7) (2) (9) (25) (3) (28)
Total 170 9 179 27 6 33 197 15 212
In both sexes, percentage of insane among successful = 8.04 per cent.
In both sexes, percentage of insane among failures = 20.80 per cent.
Pencentage of total females of grand total, 7.07 p. c.
Percentage of total insane, 15 56-100 p. c.
Female insane of total females, 40 p. c.
Male insane of total males, 13 70-100 p. c. t
Percentage of insane among insane, successful, 21 21-100 p. c. (including
wounded, 4848-100 p. c).
Percentage of sane among sane, successful, 4468-100 p. c. (including
wounded, 5530-100 p. c).
POLITICAL ASSASSINS.— Dr. E. C. Spitzka.
139
FATE OF PRINCIPAL ASSASSIN IN 216 CASES OF ASSASSINA-
TION OF PROMINENT PERSONS, AND 5 OTHERS ("O").
(In 147 cases the deed was committed by single assassins, in 69* by two
or more in actual co-operation.)
SUCCESSFUL
CASES.
Capital punishment inflicted 45
Retributively put to death otherwise 15
Suicide 3
Sentenced to capital punishment, and sen-
tence commuted to imprisonment 2
Imprisoned otherwise 1
Declared insane 4
Otherwise immune 5
Escaped or banished 2
Remained unidentified 5
Fate not ascertained 4
FAIL-
'0."
URES.
TOTAL.
5
66
Il6
5
20
9
12
6
8
10
11
23
27
1
6
2
4
0
5
8
12
86 5 130 221
* In these 69 plots the number of conspirators of whom individual men-
tion is made in records is 130.
SUCCESSFUL
CASES. FAILURES. TOTAL.
Ratio of cases where* capital punishment
was inflicted on principal offender per
1000, among those of ascertained fate. . . . . 548
Ditto, put to death retributively otherwise. . 182
Ditto, committed suicide 36
Otherwise punished, imprisoned, banished,
or self-expatriated ; and confined in insane
asylums 109
Remained unknown or immune after legal
process 121 8
* "O" excluded ; in all cases of this class, capital punishment overtook the
principal of, cr all of the offenders.
540
40
73
33&
544
98
58
245
53
THE GENESIS OF EPILEPSY CLINICALLY CON-
SIDERED. THE PATHOLOGY, PROPHYLAXIS
AND TREATMENT OF EPILEPSY.
ILLUSTRATED BY CASES AND STATISTICAL TABLES.
BY LOUISE G. ROBINOVITCH, B. ES L. (PARIS), M. D.
Foreign Associate Member Medico-psychological Society, Paris; Member New York
Academy of Medicine.
(Continued.)
THE ROLE OF ABSINTHE IN THE PRODUCTION OF CONVULSIONS.
Absinthe induces true epileptic convulsions. — Its action is es-
sentially convulsant. — The offspring of absinthe drinkers, like
those of ordinary alcoholics, are apt to be epileptics. — Cases.
In case / we have seen how quickly, within the course of some
few days and nights of heavy indulgence in absinthe, an active
and most painful delirium takes place, — as contrasted with the
slower development of the simple alcoholic delirium. We have
seen, also, that in most cases of simple acloholism, the epileptiform
attacks require a certain preparation of the brain before they can
be manifested ; after some years' preparation, dizziness and vertigo
appear, then come the epileptiform attacks. The action of ab-
sinthe, on the contrary, differs in this respect: — it causes almost
immediate convulsive manifestations.
"It is not necessary to insist on the epileptic attack ; the graphic tracings
obtained during the attack, in the numerous experiments made on animals,
establish the fact, in the clearest possible manner, that the convulsions
are an exact reproduction of the epileptic cycle : tonic convulsions, followed
by clonic ones, rapid and short at first, then more and more slow and dis-
tant, ending in rest.
"We know, besides, that the essence of absinthe causes delirium in the
dog, and that the attack of hallucinatory delirium becomes the more man-
ifest on the introduction of the poison into the stomach. Thus, in one
of my experiments, twelve minutes after an epileptic attack, one sees,
all of a sudden and without any provocation, the dog straighten itself upon
its hind legs, the hair disheveled; its looks angry, the eyes are injected and
brilliant. It directs its looks towards any point, although there is nothing
to attract its attention, it stiffens, the neck is stretched, and the animal is
ready to jump; it advances and retreats successively, it barks and struggles
furiously, grinding its teeth, jumping abruptly to catch its imaginary
enemy; it then shakes its head from side to side, the teeth close to-
gether, as if ready to tear its prey. Little by little, it becomes calmer,
again gazes, growling in the same direction, then is reassured entirely.
"This delirious attack, so suddenly developed, explains the precocious
delirium of absinthe drunkards. It develops as if after the administration
of certain poisons, of hyosciamus, belladonna, or dature stramonium, and
this rapidity in the development of the intellectual disturbances is one
GENESIS OF EPILEPSY.— Dk. Robinovitch. i4i
of the distinctive characters between the action of absinthe and that of
alcohol ; the latter, indeed, needs, in some way, to prepare the soil, and it
is onl> at the end of some weeks that the delirium develops.
"Finally, it happens that under the influence of small doses of esseace of
absinthe the dog stops all of a sudden, stupified, the head lowered, the
tail hanging down, the appearance dejected, a stranger to all that is going
on; it is in a condition of petit mal" (Magnan, Recherches sur les Centres
Nerveux, p. 28, 1893, 2d. serie).
On man, as on animals, absinthe manifests its influence far
quicker than does ordinary alcohol. The whole clinical tableau of
alcoholic poisoning seems to be condensed, so to speak, within
the shortest possible space of time. The excitation of the senses,
the delirium, the muscular cramps, the dizziness, vertigo, and,
finally, the true epileptic convulsions set in and follow one another
in rapid succession. Where years are necessary for alcoholic
morbid changes to be expressed clinically by epileptiform attacks,
one year, or even less, suffices to bring about true epileptic attacks
by the abuse of absinthe. The two cases below are illustrative
of this statement.
Case VI. — Chronic absinthism. — Dizziness, flashes before the
eyes, cramps, vertigo and true epilepsy develop in rapid succession.
One child, born after the alcoholic habit is acquired, dies of con-
vulsions in infancy.
R. A., 37 years old, entered the Admission Bureau, Ste-Anne
Asylum, December 8, 1897. There is no detailed history of his
antecedents, but from, what can be learned there are no facts of
clinical importance in the family history. The patient enjoyed
good health up to the age of 29 years, when he began to indulge in
alcoholic excesses. He took from one to seven "absinthes" daily.
During the first year of this intemperance he manifested symptoms
of absinthism: he suffered from painful hallucinations at night;
he had cramps in the legs and arms; giddiness and vertigo were
soon added to that clinical picture. He married in 1894, and the
child that was born from this marriage died of convulsions, 22 days
after birth. The patient continued in his excesses and, in 1897,
the effect of the abuse of absinthe became most manifest ; the at-
tacks of vertigo now came on twice a week ; there was ringing in
the ears, and flashes before the eyes, but he did not have any frank
convulsive manifestation. His comrades, however, had noticed that
he was "losing himself" (il perdait la tete) of evenings. Suddenly,
without any warning, he seemed dazed, and acted strangely after
the spell. When told about the strange behavior he looked as-
tonished and said that he remembered nothing of the incident. On
December 3, 1897, he went to his work as usual, attended properly
to his business throughout the day, but at 6 o'clock in the even-
142
GENESIS OF EPILEPSY.— Dr. Robinovitch.
ing he suddenly abandoned his work and left the shop without
saying a word to any one. He did not return home, and after
waiting for him a reasonable length of time his wife went to make
inquiries at the shop. No one knew anything of his whereabouts
and an alarm was sent out. The Prefecture of Police helped in
the search; at the end of some three days the patient was finally
found, stealing goods from a stand outside a store.
When brought to the Infirmary of the Depot and questioned as
to his whereabouts during the three days, he could give no in-
formation; he had no recollection of having left the shop at
6 o'clock, nor about having been absent three days.
At the Admission Bureau he looked dazed, although he an-
swered questions addressed to him. It was only towards evening
of December 7 that he regained consciousness of his surround-
ings. All that had transpired, from the moment he had left the
shop up to that moment, was a perfect blank to him.
Case VII. — Chronic absinthism. — Rapid development of true
epileptic attacks. — Post-epileptic delirium of a grave nature. —
Somnambulism. — Attempted parricicde and homicide. — Traces of
hereditary mental degeneracy.
P. G., 2J years old, printer, entered the Admission Bureau, Ste-
Anne Asylum, March 4, 1899. His father, 50 years old, is a tailor,
has a violent temper, drinks heavily and often suffers from severe
attacks of alcoholic delirium. His mental faculties are impaired
and he is in a condition of dementia. A sister is subject to hys-
terical convulsions.
The patient has been stubborn and refractory since childhood.
At the age of four, he would leave the paternal house and on being
questioned, would refuse to tell where he had spent his time. Later
on, at school, he would leave the class room during a lesson and
go wandering about the streets. He was of a violent disposition
and beat children without provocation. He had neither dis-
eases nor convulsions during childhood. When 14 years of age,
he entered as apprentice in a printing house and soon became ad-
dicted to acolholic drink. At the age of 19, he chose absinthe as
his favorite beverage. Up to this time he had seemed to be in
good physical condition; at least, — his health had attracted no
attention, but after a short term of indulgence in absinthe he be-
came much excited, tried to quarrel with those near him, and on
one of these occasions, while quarreling, he suddenly screamed out
and fell to the ground, convulsing in all his body and limbs. The
attack lasted some minutes, the tongue was bitten and bleeding,
and he passed urine invountarilly. He remained stunned
and stupefied and then fell asleep for some three or four hours.
GENESIS OF EPILEPSY.— Dr. Robinovitch. 143
On awakening, the occurrence, from the time he had fallen to the
time he regained consciousness, was a blank to him. Within the
course of two months another epileptic attack took place ; after that
the intervals between the attacks grew shorter and shorter and on
March 26, 1891, he was brought for treatment to the Admission
Bureau, Ste-Anne Asylum.
His parents stated that after having indulged in absinthe he
wandered away from the parental house and was absent eight
days. At the end of that time he bought a revolver, loaded it and
coming home, leveled it at his parents; he was about to fire when
he faltered, shrieked and fell in a convulsive attack. On recov-
ering consciousness he had no recollection of having attempted
parricide. Nov. 16, 1891, marked his fourth admission to the
asylum; he was arrested while engaged in a desperate struggle
with police officers, threatening, knife in hand, to kill the first man
who dared lay hands on him. December 13, 1895, he was again
admitted to the asylum. His hands trembled, he had delusions of
persecution, — people in the shop laughed at him, exchanged signs,
with the intent of coming to an understanding about doing him
harm, and made his existence intolerable. Exasperated by this,
he felt impelled to kill his persecutors. He pulled a revolver
out of his pocket and was about to shoot, when he hesitated and
stopped in the act. But the impulse to kill was intense; he again
leveled the weapon, but his will power prevailed, and in a su-
preme effort he succeeded in throwing the revolver out of the win-
dow.
He continued indulging in drink and, when about 26 years old,
became a victim to daily convulsive attacks. His mother asserts
that the severity of the attacks was proportionate to the amount
of absinthe he swallowed. After the attacks the patient has post-
epileptic delirium, as has been seen above. He fears that people
are going to poison him, that poisonous powder is put in his meals,
etc. Two months before the last admission he had hallucinations
of sight ; he imagined that he saw the poison, in shape of a pow-
der, being put into his food. His eyesight is now beginning to
fail him ; objects look blurred and indistinct.
III.
ANATOMICAL PATHOLOGY OF CHRONIC ALCOHOLISM.
The study of alcoholism is closely connected with that of epi-
lepsy.— The intimate cerebral changes seem to be identical' in both
cases.
As alcoholism is closely connected with the birth of epilepsy, the
144
GENESIS OF EPILEPSY.— Dr. Robinovitch.
pathology of alcoholism becomes one of importance in the study of
epilepsy.
The pathology of chronic alcoholism, compared to that of epi-
lepsy, has been the study of many workers in this line of research
and most of them seem to agree as to the similarity of the micro-
scopic appearances of the brain structure in both instances.
"Experiments on animals, in whom the intoxication does not at-
tain as marked a degree as in man, show, nevertheless, simul-
taneously with the fatty degenerative process (steatosis) of the
majority of the organs, liver, kidneys, and heart, a tendency to
chronic inflammation of certain tissues : the pericardium, the renal
and hepatic capsules and the meninges.
"In man, indeed, chronic alcoholism imprints itself in indelible
traces in the majority of the tissues and organs ; the connective net-
work as well as the parenchymatous tissues are compromised at the
same time.
"Is it necessary to call to mind the changes in the arterial system,
the arterio-sclerosis, the atheroma which make of an alcoholic of
40 an old man of 70? This premature old age is translated, in
the sphymographic tracings, by an extensive flatness of the apex.
The steatosis of the liver and the granular degeneration of the kid-
neys reach a marked degree ; the heart is overloaded with fat and
the muscular fibres themselves are invaded by the granulo-fatty
degeneration. The brain, in an advanced stage, shows, some-
times, lacunae in the opto-striated layers and sometimes also
hemorrhagic foci or more extended softenings in the centres as
well as in the cortical centres. All observers find and point out
the steatosis, the diffuse sclerosis, the chronic inflammation of the
capsules or interstitial connective tissue of the small vessels."
(Magnan, Recherches sur les Centres Nerveux, p. 51, 1893, 2e
serie. )
An English authority on cerebral pathology, Bevan Lewis, says,
in speaking of the pathology of the brain of alcoholic subjects :
"Through the medium of the blood vascular system, alcohol, by
its ready absorption and permeability, is rapidly conveyed to the
most distant parts of the organism, establishing widespread consti-
tutional disturbances; whilst through the peculiar selective ca-
pacity of the nervous centres for this poison, it thereupon expends
its primary and most potent influence. Although in all cases the
nervous centres bear the chief brunt of its attack, it by no means
follows that the subjects of chronic alcoholism suffer in the same
way. In one, the gastric, in a second, the hepatic, in a third, the
renal and cardiac symptoms may come to the front; whilst in
others, the nervous centres express the special virulence of the
GENESIS OF EPILEPSY.— Dr. Robinovitch. i45
agent in their direction. Undoubtedly, a neurotic heritage plays
a foremost part in thus predisposing to more exclusive determina-
tion of the morbid agency up the higher nervous centres. A chronic
inflammatory state leading to extensive atheromatous and fatty de-
generation of the intima is the first apparent effect, associated with
which we find parallel changes undergone by the advantitial sheath
in the increase and fatty degeneration of its elements. Fat emboli
are frequently established in the smaller cortical vessels during the
progress of these changes, and the extensive dilatation and aneuris-
mal states described above are probably direct results of the dimin-
ished resistance of the vessels, and paralysis of its muscular coat.
An extensive endarteritis of a most chronic and insidious character
affects the ultimate terminal radicals of the cortex, and, with the
pre-existing change in the composition of the blood, leads to the
devitalisation of the nervous tissues, undermining the nutritional
stability of the nerve cells. The subsequent change of the inter-
stitial tissue around, and the nervous elements themselves, appar-
ently depends much on the subject's predisposition, which seems
to be the chief determining factor in engendering the fatty or scler-
ous change which characterises these two classes of alcoholic sub-
jects. In all alike, however, we find the tendency to degeneration
of tissue in the replacement of the normal element by new con-
nective growth; but in some we find a special tendency to exten-
sive fatty changes in the nervous centres, so that the parallel de-
generation seen elsewhere, as in the fatty or the sclerosed liver,
seems to be also reproducted here. It is probable that the fatty
change is altogether a more acute process, and the sclerosis the re-
sult of a much slower and more gradual poisoning of the tissues ;
the fatty change, however, is much more liable to be induced in the
case of senile alcoholics. We may take it that the changes observed
in the cerebral meninges as well as in the soft investments of the
cord, when affected, are undoubtedly indicative of a very chronic
inflammatory action proceeding in the vessels of the membranes,
slowly involving the upper cortical strata ; for thus only can we ex-
plain the frequent association of membranes opaque and thickened,
and the- permeation of the cortex along the vascular tracts by dense
connective networks. Much of the opacity of these membranes is
undoubtedly the resulting change of years of excessive indulgence,
for it is induced slowly in all cases of long continued alcoholic in-
dulgence, apart from the establishment of acute insanity ; thus, in
most criminals, who are notoriously addicted to drinking, we dis-
cover such opaque and thickened membranes and this usually in
the postero-parietal regions of the brain. (Henry Clarke.)
Coincident with this implication of the membranes, a similar
146 GENESIS OF EPILEPSY.— Dr. Robinovitch.
change is found throughout the nutrient supply of the medullated
substance of the convolution, which, as before stated, leads to im-
portant changes in the lowermost series of nerve-cells, the spindle-
layer and medullated nerve-fibres themselves at this site. It is
obvious, on examining several cases, that the one site may be
chiefly affected to the greater or lesser exclusion of the other, and
that, thus, a sclerous change in the principal zone of the cortex may
preponderate over any morbid change at a greater depth, or that
this deeper implication may be the more expressed feature, the
pia-arachnoid being free from notable opacity and thickening. It
is more usual, however, to find both areas affected, and this to a
profound degree. Certain cases of chronic alcoholism approach,
as we have seen, in their clinical features, the history of general
paralysis ; and when we come to the morbid anatomy, we find the
membranes of the brain often presenting similar appearances, both
as regards naked eye aspects and distribution of lesion. The vas-
cular implication, however, is far different, and cannot be readily
confused. In the one (alcoholism) the morbid change is cen-
tred in the atheromatous state of the inner coat; the numerous
bulgings and fusiform dilatations being also highly characteristic
of the chronic inflammatory implication. The outer or adven-
titial investment does not show the enormous nuclear proliferation
which is so notable a feature in general paralysis ; although in de-
generated vessels it will be the seat of a profusion of scavenger-
cells which entangle its walls in their processes. In the other
(general paralysis), as previously stated the morbid change is con-
centrated in the advantitial sheath, and is a far more acute irrita-
tive process in the loose external tunic of the vessel, which ex-
plains the more rapid implication of the nervous structures lying
immediately around by direct extension. It is on this limitation
of the more gross change for a time to the inner tunic of the blood
vessels in chronic alcoholism, that the slow (yet progressive) im-
pairment of nutrition of the nerve centres depends, which so fre-
quently issues in steady enfeeblement of the mental faculties, akin
to the advancing imbecility of senile atrophy, in which similar
changes of the vessel's wall occur. It is, on the other hand, in the
early implication and rapid spread of morbid activity along the ad-
vantitial tunic of the vessels that the more acute changes are in-
duced in the nerve-cells of the cortex in the general paralytic.
When, however, superadded to the intravascular lesions we find
sclerous tissue permeating the peripheral zone of the cortex, we
have an invasion of those most externally disposed medullated
fibres which are also involved in general paralysis. It is in such
cases, probably, that the mental symptoms assimilate to those char-
GENESIS Ob EPILEPSY.— Dr. Robinovitch. 147
acteristic of general paralysis. The sclerous shrinking of the new
connective formation around the extensions from the underlying
ganglionic cells, results in a degeneration which is ultimately
transferred to these cells themselves, inducing the already de-
scribed pigmentary and fatty degeneration preceding their absolute
destruction and removal ; but this extensive atrophy of these large
elements of the cortex is coincident only with the advanced forms
of alcoholic dementia; the earlier stage of vascular impairment,
and the growth of the young scavenger-cells in the peripheral
zone, ere the cells are themselves involved, being apparently asso-
ciated with the maniacal excitement and early delusional perver-
sions of alcoholism. It is certainly a remarkable feature that in
both affections we get a similar implication of the vascular chan-
nels of the pia over the almost identical motor realms of the cor-
tex; that in both the same nervous elements are primarily in-
volved; and that, clinically, there are presented to us so many
features in common between the two affections that it often be-
comes a moot point of diagnosis. This peripheral implication of
the cortex would appear to us to explain the grandiose feeling so
frequently commingled with the delusions of persecution, from
which alcoholic subjects suffer; the notions of wealth, of landed
possessions, of exalted social status, which we find so often under-
lying delusions of restricted liberty, or of malign influence brought
to bear upon them. When, however, the motor cells and axis-
cylinder processes are themselves involved, then we find the char-
acteristic delusions of persecution predominate to the exclusion
often of such optimistic states ; and the profound implication of the
"motor element" of mind may call forth ideas of restricted voli-
tional freedom and reactive capacity. In all the more character-
istic phases of chronic alcoholism, we never fail to identify these
profound lesions within the white medullated substance of the
fronto-parietal lobe, associated with the degeneration and break-
ing up of the large motor cells and spindle-series. Whilst, there-
fore, the cortical lesions of general paralysis indicate an invasion
from without inwards, affecting the sensory elements and apical
(? sensory) poles of the motor-cells; alcoholism induces, in ad-
dition thereto, extensive vascular changes from within outwards,
implicating the medulla of the gyri, and effecting a destructive de-
generation of the medullated fibres." (W. Bevan Lewis, a text
book of mental diseases, p. 536-539, 1889.)
The preceding description of the cerebral pathology of chronic
alcoholism is magistral. Although there have recently been pub-
lished some contributions to the same study, there is nothing new
to be found of essential value bearing on this question. The
I48 GENESIS OF EPILEPSY.— Dr. Robinovitch.
younger authors devote some space to the dendritic degeneration,
but, on the whole, the field is well covered in the chapter quoted.
In a chapter on the pathology of epilepsy, Bevan Lewis
brings to light the important fact that the microscopic appearances
of the brains of epileptics are similar to those found in subjects suf-
fering with chronic alcoholism.
He says that the change in the cell of the epileptic is not peculiar
to epilepsy. "It is found in other diseases and especially alcoholic
brain disease. The nucleus of the cell is the earliest portion af-
fected, the cell protoplasm being apparently secondarily involved
(p. 522). With the atrophy and disappearance of the nucleus
we find associated declining functional activity and ultimate de-
generation of the cell itself. Displacements, distortion, degenera-
tion, enfeebled vitality, and the absence of the nucleus are constant
accompaniments of cerebral disturbances characterized by loss of
inhibitory control. This idea is not in contradiction to the fact
observed in acute anaemia, where the suddenly induced absence of
nutrition causes, — on the mental side loss of consciousness, and
on the physical side general convulsions (p. 526). A nutritive
irritability underlies the morbid activity. Where mental disturb-
ance predominates and actual insanity co-exists with epilepsy, there
is a notable affection of a special series of cells, not exclusively
seen, however, in this disease, for it likewise prevails in other con-
vulsive affections, such as chronic alcoholism wherein spasmodic
discharges of nerve energy are frequent (p. 525). With epilepsy
is associated ancestral intemperance. Is it probable that the nuclear
and cellular changes bear the imprints of ancestral vice? (p. 527).
Disparity between nucleus and protoplasm, and the displacement or
degeneration of the former, seem to bespeak a convulsive constitu-
tion." (p. 528.)
REFERENCES.
i. Vide: Dr. Robinovitch. Idiot and imbecile children, etc.
Journal of Mental Pathology, Nos. 1 and 2, 1901.
2. Bevan Lewis. Text book on mental diseases, chapter on the
pathology of epilepsy.
3. Dr. Robinovitch. On the duty of the state in the matter of
the prevention of the birth of crime and of its propagation, Journal
of Mental Pathology, No. 3, 1901.
(To be continued.)
The Journal of Mental Pathology.
Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. II. APRIL, 1902. No. 3.
STATE PUBLISHING COMPANY, Publishers,
290 Broadway, NEW YORK.
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28 West 126th Street, New York.
Address bulky mail matter to P. O. Box 1023, New York.
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Price of subscription, $2.50 per annum. Single copies, 50 cents.
Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope. News items from Institutions will be given all space
available.
Pleading for reform in the administration of the Criminal Law
in the State of Maine, Dr. Addison S. Thayer, of Portland, Me.,
cites the history of five cases in all of which the defendants were
convicted of murder in the first degree. The doctor clearly dem-
onstrates that the "criminals" were hereditarily and hopelessly in-
sane. Two of the convicted "murderers" died insane while under
sentence, and three are now complete dements. In one case, eight
medical experts testified, of whom five were called in for the State
and three for the defense, and they all agreed that the defendant
was insane and that his homicidal acts had been the results of in-
sane promptings, but all this testimony did not avail : the defend-
ant was convicted of murder in the first degree.
The significance of this attitude of the laity to professional
opinion is not to be lost sight of. It shows that the public has no
confidence in the expert opinions of the members of the medical
profession. Where there is effect, there is cause. Is it not time
that we recognized the fact that we need a higher standard of
psychiatric instruction? Is it not apparent that the would-be
psychiatrist cannot take his proper position before the tribunals of
150
EDITORIAL.
justice, and before the community, until he has demonstrated his
unwillingness to testify either for the defense or for the prosecu-
tion as an expert for the defendant or for the People respectively,
pure and simple? The duty of the medical witness when called
on for his expert opinion before the tribunal of justice is to give
his opinion to the community regardless of any distinct interest.
Our duty at the present moment is to see to it that a system of
administration of justice is inaugurated that will do away with the
hiring of medical testimony for this party or that and which will
appeal to the medical expert in the same spirit as both contestants
now appeal to the judge presiding on the bench.
In a fit of "political economy" a governor of a certain State in
the Union recently recommended a reduction in the appropriation
for School Funds. Commenting on this, the inimitable Mark
Twain recently said that he recalled the results of a similar act in
which a similar official indulged some years ago. The particularly
irrelevant coincidence which attracted Mark Twain's attention
was the fact that at or about the time immediately following the
enforcement of this policy the prisons for juveniles in that locality
experienced a remarkable increase in population.
On April 15, Gov. Odell of New York signed the bill introduced by
Senator Brackett, amending the insanity law so that the Manhattan State
Hospital, on Ward's Island, shall be divided and have separate Superin-
tendents and stewards.
"THE TOMBS ANGEL."— Mrs. Rebecca S. Foster, a noble
woman, who devoted her life to the task of improving the condi-
tion of prisoners, spending her money to afford them whatever
comforts could be afforded them, gained the above name. She was
killed in the recent fire at the Park Avenue Hotel, the worthiness
of her life in her field of labor being emphasized by the void that
her death has occasioned.
A NEW PSYCHOPATHIC WARD According to the Med-
ical Record for March 22, 1902, a psychopathic ward has been
founded in the building of the New York Infirmary for Women
and Children. The trustees of that institution, through the influ-
ence of Dr. Alexander Lambert, have brought about this culmina-
tion of efforts in that direction. Dr. Ira Van Gieson is appointed
Director of the Neuropathological Laboratory, Dr. Boris Sidis is
appointed Director of the Psychopathological Laboratory and Dr.
George M. Parker is Assistant in Psychopathology. Dr. Deady is
to take charge of the ward.
OLFACTORY SENSIBILITY IN GENERAL PARALYSIS. I5I
EXPERIMENTAL RESEARCHES IN THE OLFAC-
TORY SENSIBILITY IN GENERAL PARALYSIS DRS.
TOULOUSE and N. VASCHIDE state that the study of the
acuteness of the senses has been rather crude in method, as the
instruments and substances employed in the experiments have
been limited to pins, needles, bodies heated to an indefinite degree
and odoriferous substances of indefinite strength. In their re-
searches, relating to the olfactory sense in general paralysis, the
authors have used camphor water of definite degrees, and com-
parative experiments have been made in normal subjects.
It was found that among the general paralytics the number of
cases of anosmia (those who did not recognize any odor) was
8 out of 1 8, — almost one- third, whereas it is only one-thirteenth
among normal adults.
Dr. A. Voisin gave it as his opinion that anosmia was one of the
most valuable signs during the initial stage of general paralysis,
when the diagnosis is of importance. He said :
"The diminution or loss of the olfactory sense, either on one,
or both sides, is one of the signs to which I have long since called
attention. Since 1867, I have been studying this phenomenon, its
causes and its high diagnostic value.
This is one of the most priceless diagnostic signs in the incipient
stage of general paralysis because: 1— It is almost always pres-
ent; 2 — it does not characterize any other disease than general
paralysis, save some exceptional case (ozena, an old fracture of
the ethmoidal bone; in simple insanity, the olfactory sense is
rather augmented than diminished) ; 3 — this initial sign may be
found before even the tongue tremor and the inequality of the
pupils are observed, and even before signs of enfeebled memory
are manifested ; 4 — this sign is easy of recognition, as it is persist-
ent, while the others are rather non-continuous in manifestation.
Pepper may be used as the odoriferous substance ; if the patient
does not recognize its smell while his eyes are shut, it is well to
show the substance to the patient ; if he does not recognize it, he
is suffering from dementia ; but if he does, then he is simply sub-
ject to impaired sensation of smell.
Most frequently the odoriferous substance does not produce any
sensation ; at other times there is a sensation, but it is perverted ;
the patient mistaking the odor of pepper for that of tobacco, or
camphor ; once out of ten times, however, the smell of pepper is
recognized ; the sense of smell may often remain intact on one side.
Hallucinations of smell are very rare in the initial stage of
general paralysis, whereas they are very frequent in simple or
neuropathic insanity.
152 OLFACTORY SENSIBILITY IN GENERAL PARALYSIS.
These disturbances of smell depend on alterations of the olfac-
tory nerves. In the beginning of the development of the disease,
the general paralytic has a sensation of an obstruction or of the
presence of a foreign body in the nares, or else there may be an
itching sensation ; the subject tries to extract the imaginary body
from the nose, or else to expell it by forced blowing of the nose.
As the sense of taste is intimately connected with that of smell,
the sense of taste is generally found to be impaired at the same
time as that of smell.
It may be stated that the olfactory sense is generally gravely
compromised during the first stage of the disease and remains
abolished during the second period. This explains the reason why
the patients do not seem to be incommoded by the odor of fecal
matter, which they smear over their faces."
The authors have also observed the symptom of a sensation of
foreign bodies in the nose among patients afflicted with general
paralysis, but the disturbance was of tactile, not of sensory na-
ture; besides, these sensations were seen to exist not only during
the first period of the disease, but throughout the course of it.
The olfactory hallucinations of which M. Voisin speaks are
rather false hallucinations, verbal images, relating to purely intel-
lectual associations.
The point that is confirmed is the fact that the loss of the olfac-
tory sense is a prominent symptom during the course and at the
end of this disease. Ballet and Blocq were of the opinion that
anosmia was a disturbance of trophic nature and characteristic
of the advanced stage.
According to M. Voisin, the olfactory bulbs show, microscopi-
cally, degenerative changes in their anterior parts, but partic-
ularly in the regions of their apparent origins.
According to M. Voisin, this degeneration is akin to that char-
acterizing the general cerebro-pathological changes found in gen-
eral paralysis ; but Dr. Collet thinks that the olfactory nerves are
especially susceptible to this degeneration, on account of their
anatomical structure.
The tactile sensibility test was made by means of ammonia
water, which ordinarily produces a sensation of pricking or burn-
ing or of suffocation. The solutions were graduated, i in 10, i in
ioo and i in 10,000, all at 22 degrees C. In the normal subject
these sensations are perceived even by senile cases, in whom the
sense of smell is completely abolished, and by the child in whom
the olfactory sense is not yet developed ; but in the paralytic sub-
jects these sensations were decreased in proportion as the disease
was advanced.
THE BLOOD SERUM OF EPILEPTICS. 153
It is noteworthy that during the first period of the disease these
sensations are little inferior to those found in normal subjects.
From these experiments it may be concluded, incidentally, that
sensation and perception are two distinct elements.
General paralysis is essentially a type of dementia — intellectual
feebleness. It is interesting to note also that the olfactory sense
becomes abolished simultaneously with the intelligence, the sense of
perception giving way first. {Revue de Psychiatrie et de Psychol-
ogie Experimental, Feb., 1902.)
NEW TOXIC AND THERAPEUTIC PROPERTIES OF
THE BLOOD SERUil OF EPILEPTICS AND THE PRAC-
TICAL APPLICATION OF THESE PROPERTIES. —DR. C.
CENI, basing his arguments on the numerous researches of vari-
ous authors and his own work, concludes that epilepsy is due to an
endogenous toxic principle. With this idea in view he experi-
mented on epileptic subjects by injecting into their systems serum
obtained from epileptics. Injection of small doses of such serum,
instead of having a beneficial or a negative effect, brought about
symptoms of true acute infection, as well as an aggravated condi-
tion of the epilepsy.
These results demonstrated, therefore, that the serum of the
blood of epileptics contained a special toxic element.
This conclusion was strengthened by negative results obtained
from injecting the serum of the blood of healthy subjects into
epileptics.
The author then asked himself whether it were not possible to
immunize an epileptic by augmenting artificially the specific toxic
agent by injecting progressive doses of the poison contained in the
serum of the subject's own blood, or in that of another epileptic
subject. Where the subject's own serum was injected, the fluid
was obtained during an attack, and several days were allowed to
elapse before the injection was made, in order that the patient
might recover from the effects of the attack.
The experiments were carried on during a period of two years
and the results must, necessarily, carry some weight. Besides, the
subjects chosen for the experiments were the severest in clincal
nature, suffering at the same time from various psychic disturb-
ances.
Ten cases were experimented on, both methods being used, and
the dosage being progressively augmented. In eight of those the
treatment showed its eminently therapeutic and reconstructive
properties, while in two cases the serum acted as an epileptogenic
and toxic agent.
154 THE BLOOD SERUM OF EPILEPTICS.
In five of the cases, in whom the serum acted as a therapeutic
and reconstructive agent, the serum was produced from other epi-
leptics, while the remaining three were injected with the serum of
their own blood.
Of the two, in whom the serum acted as an epileptogenic and
toxic agent, the subject's own serum was used in one case and that
of another epileptic in the other.
As for the effects produced in the eight cases, there was a notice-
able improvement in the general nutritional condition as well as a
striking amelioration of the pathological phenomena.
In six of these cases, who had been suffering from epilepsy for
from 10 to 20 years, the fits decreased in severity and in frequency,
disappearing completely in some, and the body weight increased
from 6 to io kilograms, after a period of treatment of from 5 to 6
months.
In three of these cases, the treatment was suspended and the
epileptic disturbances began to reappear, but to such a slight de-
gree that even two years after the suspension of the treatment the
return of the disease was only of a slight degree, and there is
reason to doubt whether there will be a complete recurrence of the
malady.
The other three cases, in whom the treatment had been similarly
suspended, the amelioration was not impaired two years later.
In the two cases, belonging to the group of positive results, and
in whom epilepsy had existed for from 3 to 4 years, the fits com-
pletely disappeared after the first month of treatment. After the
fifth month of treatment, the body weight increased 10 kilograms
in one and 29 kilograms in the other.
The psychopathic symptoms had also completely disappeared,
the individuals presenting a normal appearance, — during a period
of two years, and giving every indication of an accocmplished final
cure.
The two cases that gave negative results were suffering from
congenito-hereditary epilepsy ; not only were the results negative
here, but there was a decided toxic effect produced by the injec-
tions, as there was a progressive increase in the severity of the
attacks as well as of the mental condition, a return to their usual
condition being effected only on suspension of the treatment.
These experiments show that the blood serum used had some
active principle. It is now important to establish whether that
active principle is peculiar to the serum of the epileptic, or whether
it is peculiar to the serum of the human blood in general. In order
to bring this point to light, the author made a series of control
experiments on other epileptics, injecting into their systems pro-
A CASE OF ACUTE DELIRIUM. 155
gressively increasing doses of serum drawn from normal subjects.
In none of these new cases could there be observed either posi-
tive or negative reactions, so clearly observed in the other cases.
The property of modifying the general as well as the specific
conditions of the epileptics is contained, therefore, in the serum of
epileptics and not in that of human blood in general.
It now remained to be determined whether there was a difference
between the action of the serums injected from the subject's own
blood and that obtained from the blood of another epileptic. An-
other striking fact to consider was that the serum of the same
epileptic injected into different epileptics, gave opposite results,
acting as a therapeutic agent in one case, and as a toxic and epilep-
togenic in another.
These questions will be treated of at length in a future work ; for
the present it is remarked that the question is easily explained on
the ordinary principle of cellular regeneration. The serum of epil-
eptics contains a specific regenerative agent ; it improves the physi-
ological condition of the cellular element in those whose cells are
not degenerated past redemption, while it only aggravates the con-
dition of subjects whose cell-degeneration has reached an advanced
stage.
As regards the action of the serum of the epileptic's own blood,
it must be supposed that the active principle circulates in the blood
in a latent condition; that in the physiological condition of the
blood this principle is soluble, remaining inert ; but that it acquires
its properties when exposed to external contact, and the blood ele-
ments cease to live. (Rivista di Patologia Nervosa E Mentale,
November, 1901.)
A CASE OF ACUTE DELIRIUH.— DR. BUVET adds to the
list of similar cases a case of cure of insanity by shock. The
patient was born of alcoholic parents, was an alcoholic herself and
was married to an alcoholic. She had lost her first child, who died
of "convulsions" and was severely tried when her only living child,
4/^ years of age, fell ill with meningitis. She was menstruating
when this child died, and the flow ceased suddenly on that day.
She became violently agitated and was taken to an asylum. There
she kept up an unceasing and exhausting agitation. Although the
urine was free from albumen, the case was considered as being
one of toxic maniacal excitement. When she was admitted to Dr.
Briand's wards she was given the serum treatment, one litre being
injected at a time. There was a marked febrile movement and
the maniacal excitement kept up during a period of three months.
While she was in this uncontrollable state of mental excitement,
156 A CASE OF CIRCULAR INSANITY.
apparently unconscious of her surroundings, she was conducted to
take a bath. She was held in the bath room to await her turn,
when suddenly another patient jumped upon an attendant and
seized her head, intent on submerging it in the bath tub. As another
attendant came up to help her comrade, the infuriated patient
dealt some blows right and left, and turning again on her first
would-be victim, seized her again and attempted for the second
time to drown her in the bath tub.
The patient considered in this paper, terrified at the sight of
the violence enacted, ran out of the bath room, screaming for help,
and as she reached an alarm bell, rang it vigorously until help
came. She then crouched in a corner, trembling with
fright. The astonishment was great, however, when she gave per-
fectly rational replies to the questions addressed to her after this
incident. • Throughout the course of the three months of her ill-
ness she had never seemed to be conscious of her surroundings,
and had talked most irrelevantly, often in incomprehensible words.
When questioned, she said that she remembered nothing of what
had happened to her during the three months of her illness ; she
was astonished to find herself among insane people. She knew
that the shock caused by the death of her child had made her ill,
but she was all right now, she said. She was kept in the asylum
two months longer ; she improved steadily in her physical condition
and was discharged as cured.
The author remarks that while he does not wish to contradict the
notion that shock may cure insanity, he still attaches some im-
portance to the beneficial effects produced by generous doses of
serum in toxic psychoses. He has described the method in his
thesis. (Gazette des Hopitaux, Jan. 14, 1902.)
See analysis of thesis in The Journal of Mental Pathology,
Nos. 4-5, 1901-1902.
A CASE OF CIRCULAR INSANITY, ALTERNATING
DAILY, OF SEVEN YEARS' STANDING, IN A SUBJECT
AFFLICTED WITH APOPLECTIC ATTACKS, WITH RE-
MARKS ON THE SO=CALLED "CIRCULAR NEURAS-
THENIA."-DR. S. H. SCHEIBER published a paper on this sub-
ject in the Arch. f. Psych, u. Nervenkrankh. XXXIV., 1, p. 225,
1 901. The patient was a physician in active practice, and there
was nothing of note in his history ; besides, he was a healthy man
and had had no diseases up to the age of 57, when a severe moral
strain brought about an apoplectiform attack, which was followed
by paresis of the right lower limb. From that time on his psychic
condition changed, marked irritability and depression replacing
ACQUIRED HYDROCEPHALUS. 157
his usual level temperament. A year later, a second apoplectic
attack took place, and from that time on, for a period of seven
years, he was subject to circular insanity that alternated
every other day with normal mentality, Two years after the sec-
ond attack a third one took place, then a fourth one which left
the patient a helpless hemiplegiac. The point of interest in this
history is the fact that the circular insanity became of a severer
form after every apoplectic attack. It seems that in this case
there must have been some psychopathic predisposition which, in
conjunction with senility (the patient died at the age of 63), and
the neurotic trouble, caused the onset of the circular insanity. In
conclusion, the author made some statements relating to circular
neurasthenia which, of late, has figured under various other names.
(Schmid's Jahrbuecher der Gesamten Medicin, Feb. 15, 1902.)
ACQUIRED HYDROCEPHALUS, LUilBAR PUNCTURE.
— DR. CARAVASSILIS reports a case of acquired hydrocephalus
which was cured by repeated paracentesis. As various other meth-
ods used in the treatment of this disease have failed to give favor-
able results, the author considers his method as being one of im-
portance. The patient was a child, 7 months of age, who had suf-
fered from acute gastro-enteritis with fever and eclampsia, acute
hydrocephalus setting in as a complication. The child was in a mor-
ibund condition, the cranial measurements were increased in both
diameters, (6cm. each), the anterior fontanelle was enlarged, the
cranial sutures were enlarged, especially the antero-posterio (3 m.
m.), and the circumference of the head was 45 c. m. ; there was
paresis of the lower limbs, diminished tendon and skin reflexes and
general anaesthesia.
The first puncture was made between the fifth lumbar and first
vertebrae, 50 c. c. of colorless and limpid liquid being drawn, and
the operation being followed by no ill consequences.
After the operation, the diameter of the head was found to be
reduced 3 c. c, measuring 42 c. m. Within the course of the next
20 hours the circumference of the head increased again, measur-
ing 44 c. c. ; besides, a new attack of eclampsia set in and was fol-
lowed by paresis of the right hand. A second operation in the
same locality as before was resorted to, and the head decreased in
size as the fluid was being drawn. General treatment was given
to relieve the symptoms, the size of the head remaining stationary
during 48 hours following the operation. The fluid distended the
head again to 44 c. c, however, and a third tapping was performed
a day later, between the fourth and fifth lumbar vertebrae, drawing
158 NICOTINE PSYCHOSES.
30 c. c. of fluid. The amelioration was not immediate, but 24 hours
later a decided improvement took place, the patient rallying, its
mind clearing up and the paresis disappearing ; convalescence and
recovery followed and the child was perfectly well two years later.
The method was after Quinque-Chipault, using the Roux
syringe instead of the trocar.
The author concludes that in cases of rapidly developing hydro-
cephalus surgical intervention should be resorted to without delay,
as the disease otherwise generally proves fatal. (Annales de Mede-
cine et Chirurgie Infantiles, December, 1901.)
1. TWO CASES OF NICOTINE PSYCHOSES DR. C. ZAL-
ACKAS publishes two cases of insanity caused by nicotine poison-
ing. Both patients were free from morbid heredity or other affec-
tions that could be incriminated as causes of the onset of insanity.
One case habitually absorbed 0.005 milligrams of nicotine daily, or
about two grams per year. The psychosis set in at first as simple
melancholia, then there developed delirium with maniacal excite-
ment. Total suppression of the use of nicotine was ordered, but,
the patient being an inveterate smoker, alarming symptoms fol-
lowed. Smoking of tobacco was then allowed in gradually de-
creasing doses and a thorough recovery took place. In the second
case gradual suppression of the use of tobacco was also resorted to,
and a satisfactory cure was thereby obtained.
2. PROPERTIES OF NICOTINE.— Nicotine is extracted from
the plant nicotina tabacum; in its pure state it is liquid, colorless,
very soluble in water, particularly so in alcohol and in ether, and
it is alkaline in reaction. The tobacco of Virginia is the richest in
nicotine ; the alkaloid is a most deadly poison to the human system.
A dose of from 1 to 3 milligrams of the alkaloid produces at first a
bitter taste in the mouth, which is followed by profuse salivation
and a feeling of warmth in the stomach, the extremities, and the
body. Then follow headache, vertigo, somnolence, visual and
auditory disturbances and accelerated respiration. About three-
quarters of an hour after the ingestion of the poison, marked
feebleness sets in; the face becomes pale, the body temperature
lowered, and collapse takes place ; there may be convulsive mani-
festations ; these symptoms generally last about three hours, but
the general effects linger during a period of some days. In general
terms, the effects of nicotine on the system, as well as on the brain
and spinal cord, are excitant at first, then depressant and finally
paralyzing.
THE ANTIDOTES OF NICOTINE. ^9
3. THE ANTIDOTES OF NICOTINE — Strychnine is generally
recognized as an antidote to nicotine, but experiments show that
the antagonism between the two drugs is nil, if the nicotine is
injected first; when the two substances are injected simultaneously,
the convulsant effect is almost triple that obtained from the in-
dividual drugs.
Eserine is another antidote. A non-toxic dose of eserine neutral-
izes a toxic dose of nicotine ; but when toxic doses of both drugs
are administered the paralyzing effect of both are combined and
prove fatal.
A third nicotine antidote to be used in the psychoses considered
is nasturtium officinale; the author uses its juices obtained by cold
filtering; caffeine should be combined with this antidote. {Pr ogres
Medical, Feb. 8, 1902.)
A THEORY OF HALLUCINATIONS, — PROF. E. TANZI
makes a review of the psychological function of the brain in rela-
tion to anatomical data, bringing out the fact that the psychic cen-
tres, corresponding to the physiological ones, must, of necessity,
be unilateral. The theory regarding hallucinations is thus sum-
marized : —
A hallucination is not a spasmodic representation, but, on the
contrary, it differs from a representation in quality as well as in
topography. Hallucinations are not the results of exaggerated
representations, as has been suggested by some ; for, one may have
visual hallucinations while the eyes are shut, and hallucinations in
general during sleep.
The origin of all genuine hallucinations is transcortical; and
hallucinations of peripheral origin, so long as they are not com-
plemented by a suprasensory coefficient, have nothing in common
with the former, are not genuine hallucinations, and cannot be
considered as belonging to psychopathological phenomena.
The mechanism of hallucinations consists of a regression of
images, more or less complex, or conscious, which, instead of
reaching the psychic zone, return to the sensory centre from which
they have come, taking on again a sensory form, to such a degree
that they are taken for reality.
This mechanism is brought into play in pathological or abnormal
conditions; the paths serving for the abnormal transmission be-
tween the psychic and sensory zones serve other more or less defi-
nite purposes during normal conditions.
Admitting that the centres of representation and sensation are
individually distinct, it is easy to conceive of a hallucination being
160 CLINICAL STUDY OF IDIOCY.
subjectively identical with a sensation, occupying an identical cor-
tical region and being perceived in both hemispheres ; but it would
be incorrect reasoning to suppose that two stimuli are necessary to
act simultaneously on both hemispheres, for in that case isolated
visual stimuli should produce unilateral representation, conse-
quently hemianopsia.
There is much similarity between this theory and that of Tam-
burini : both sensory and hallucinatory phenomena have an identi-
cal cerebral seat, if not origin ; hallucinations and sensations reside
in the same cortical centre; hallucinations are distinctly different
in nature from representations; hallucinations are nothing else
than the result of an aberration of association, due to regression ;
they are most dissimilar to representations. (Rivista di Pat. Nerv.
e Ment., Dec, 1901).
CLINICAL AND ANATOflO-PATHOLOQICAL STUD-
IES OF IDIOCY,— G. B. PELLIZZI : The various forms of idiocy
may be divided into two large classes, to each of which corresponds
a special patogenetic, anatomical and clinical basis. To the first
class belong cases with anatomical defects of cerebral development
as well as with histological anomalies of the cerebral structure.
From this group are excluded cases with defects of inflammatory
nature, either anatomical or histological. The histological defects
that exist here relate to the anomalies of form, disposition, group-
ing and seats of the various nervous elements of the cerebral cor-
tex. As a clinical basis for these cases are found: grave neuro-
psychopathic heredity (especially alcoholism, epilepsy and defec-
tive mentality) ; the subjects themselves present numerous physical
stigmata of degeneracy, special psychopathias and essential epi-
lepsy. The second class presents encephalic pathological processes
in the strictest sense of the word, the cerebral membranes being
included. Here are found absolute signs of inflammatory proc-
esses, intra- or extra uterine, involving the tissues. Clinically,
neuro- or psychopathic heredity is not the rule ; subjectively, de-
generative anomalies are either few or absent; symptomatic epi-
lepsy is a frequent accompaniment here. In the first class, those
suffering from cortical hypertrophic disseminated sclerosis are
subject to true and essential epilepsy; but the disease is an accom-
paniment of the existing idiocy ; there is no idiocy determined by
epileptic attacks. In cases of hypertrophic sclerosis the cerebral
tissues are strangled and idiocy is the necessary result. In the
history of such cases are generally found hereditary alcoholism
and epilepsy as well as other mental defects. (Annali di Fren.,
Dec, 1901.)
ACUTE CEREBRO-SPTNAL MENINGITIS. jfa
THREE CASES OF ACUTE CEREBRO-SPINAL MEN-
INGITIS. —DR. S. MICHELSON publishes three cases of cere-
brospinal meningitis, two of which died, and the results of the au-
topsy confirmed the diagnosis. The salient features among the
symptoms were severe headache that made the patients scream with
pain, vomiting, scaphoid abdomen, anaesthesia of the nape, pain in
the spine, severe delirium, spasms of the facial and other groups of
muscles, Kernig's symptom and paralyses of the oculo-motor (dila-
tion of the pupils, converging stabismus )and facial nerves; the
reflexes were diminished. The spleen was increased in size;
herpes was absent in these cases ; in two of the cases the joints were
affected ; the urine was free from sugar and albumen ; the tempera-
ture presented no characteristic traits. At the autopsy were found
various stages of inflammation of the meninges, from simple in-
filtration to purulent processes. The author is disposed to think
that the cases were of an epidemic nature. (Ronssky Medizinsky
Vestnik, Feb., 1902.)
MYXEDEMA TREATED WITH THYROID GLANDS
DURING A PERIOD OF FIVE YEARS M. HERTOGHE be-
gan to treat the patient when she was eight years old, when she pre-
sented distinct myxedematous symptoms. At present, five years
since the beginning of the treatment, the patient seems entirely free
from signs of the disease. {Annates de Medicine et Chirurgie
Infantile, Jan. 1, 1902.)
HYSTERICAL CUTANEOUS GANGRENE. — DR. CHAR-
MEIL has treated a case of disseminated gangrene of the skin due
to hysteria. There have been only about thirty similar cases pub-
lished. The author has had another case which presented, besides
the gangrenous lesions of the skin, lesions of the buccal and intes-
tinal membranes. Simulation must be excluded in such cases ; the
question here is that of arterioneurosis, and suggestion is the only
useful treatment. (L'Echo Medical, Jan. 12, 1902.)
HYDROCEPHALUS, AN UNUSUAL CASE. —DR. RAMOR
D. GARCIN publishes this case. The child was colored, about five
months old. The unusual measurements of the head that was
hydrocephalic were as follows : Circumference, 27 inches ; vault of
cranium from ear to ear, i6j^ inches ; from before backward, i6j^
inches ; circumference of back of head, 223/2 inches ; size of neck,
7 inches; wrists, 3 inches. (American Medicine, March 8, 1902.)
INSANE CONVICTS. — Of the 52 convicts serving life sen-
tences in the Connecticut State Prison more than 17 per cent, have
been pronounced insane. (American Med., Feb. 22, 1902.)
X62 OTITIC BRAIN ABSCESS.
A CASE OF OTITIC BRAIN ABSCESS, AND THE LES-
SON WHICH IT OBVIOUSLY TEACHES.— DR. ROBERT
LEWIS, JR., publishes the case of a woman, 23 years of age, who
had purulent discharge from the ear since her childhood. The
main symptoms that characterized the disease were fever, chills,
headache, rigidity of the limbs and amnesic aphasia ; an abscess of
the left ear and the third and ascending frontal convolutions were
found and evacuated ; there was also hyperemia of the dura that
covered the temporo-sphenoidal lobe.
A feature of the aphasia was that the patient felt much annoyed
at not being able to use the right words while answering questions,
"fan" being a word she substituted for many other words. The
patient made a perfect recovery, and the author points out the les-
son that similar cases should be treated surgically at an early date.
(Medical Record, March 15, 1902.)
CEREBROSPINAL MENINGITIS. — M. DUCARE pub-
lishes a case of acute sporadic cerebro-spinal meningitis, which set
in, as is usual in such cases, suddenly, the characteristic symptoms
having been exquisite cephalalgia, Kernig's sign and high fever.
The disease spontaneously terminated favorably after a course of
three weeks. (La Loire Medicate, Feb. 15, 1902.)
flELANCHOLIA AND THE TOXyEHIC THEORY; A
CLINICAL SKETCH. — DR. T. C. CLOUSTON demonstrates
by clinical cases that while toxaemia may be a vulnerable factor in
the causation of an onset of insanity, it must be borne in mind that
insane or nervous heredity generally underlies the disturbance.
(The Scottish Med. and Surgical Jour., February, 1902.)
LIQUOR REFORM IN RUSSIA. — The attempt of the Rus-
sian Government to abate the drinking habit of its nation, by bring-
ing the liquor trade under state control and by obliging the buyers
of liquor to carry the drink home, has ended in a financial success,
but not in a social one, Mr. Mennan says. Sputnik Zdorovia says
that the moral elevation of the nation cannot be expected before the
physical level, in all its relations, is raised. (Medic. Rec, March
1, 1902.)
SUICIDE IN THE UNITED STATES. — Suicide is on the in-
crease. The total number for the year 1901 was 7,245 as compared
with 6,755 in 1900, and 5,340 in 1899. Of this total 5,850 were
males, and 1,395 females, showing the same proportion of about
5 males to 1 female for several years past. Physicians head the
list among professional men, the record standing : Physicians, 33 ;
AN EPIDEMIC OE LAUGHTER.
163
attorneys, 10; clergymen, 10; bankers, 6; journalists, 6, and col-
lege professors, 1. (Med. Record, March 1, 1902.)
AN. EPIDEMIC OF LAUGHTER. — Three cases of remark-
able laughter, in regard to its onset as well as duration, are re-
ported to have occurred in Wellington, 111. The first case was that
of a girl, 15 years of age, who laughed four days in succession.
The spell was cut short by the effect of a glass of cold water being
thrown into the girl's face by her father. The second case was that
of a girl, 15 years of age, and the third, that of a young man. In
these two cases the victims stopped laughing, probably from sheer
exhaustion, after a week's duration of the disease. (St. Louis
Med. Review, Feb., 1902.)
RENAL PERHEABILITY OF EPILEPTICS TO ME=
THYL BLUE — DR. SOTGIA is of opinion that the results of ex-
periments on renal permeability in the epileptics may become use-
ful only as comparative qualities; he has found that traces of
methyl blue injected before or during an epileptic attack can be
detected from one-half to three-quarters of an hour after the in-
jection is made, the last traces disappearing from 56 to J2 hours
after the injection; but these results should be compared with
others, obtained on healthy subjects, as well as on epileptics in
various stages of the disease. (Annali di Fren., Dec, 1901).
THE SEXUAL SELECTION AND THE PROGRESS OF
ESTHETICS.— DR. MAROTTA concludes from a review of the
entire zoological scale that the feminine individual is always the
inferior subject in development. In human ranks, as in others, her
forte lies in her beauty. The latter is the higher as it is the more
suggestive "of sexuality. The Venus of Milo is a distorted concep-
tion of feminine beauty because her form is inconceivable in con-
nection with maternity. (Annali di Fren., Dec, 1901).
CONGENITAL HALFORMATION OF BOTH UPPER
LIMBS TRANSMITTED FROM MOTHER TO CHILD.—
M. JABOULAY published the case in the Province Med. de Lyon,
stating that the mother, who had only four fingers on the right
hand and an absence of the thumb and radius of the left limb, gave
birth to a child with precisely similar defects. ( Gas. des Hop. de
Toul., Jan. 11, 1902).
INSOLATION AND PSYCHOSIS. —DR. REGIS is of the
opinion that insolation acts on the nervous system in a manner sim-
ilar to that produced by the poisons of auto-infections. Dr. Hys-
lop's study of the subject is the most complete at present. A case
l$4 BRITISH CHILD STUDY ASSOCIATION.
of insolation of a young soldier is reported, which is interesting
because of the persistent retrograde as well as anterograde amnesia
during a period of eleven months after the onset of the disease.
While the patient forgot what had been told him a minute before,
he memorized thirty-two lines of verse that were given to him as a
test, and he could recite the lines without mistakes some weeks
later, without having looked them over during that time. Dr.
Regis suggested the trial of hypnotism in this case. {he Cadncee,
Nov. 6, 1 90 1.)
THE BRITISH CHILD STUDY ASSOCIATION. — This
association has been established, having ten branches in various
towns in the Kingdom. The object of the association is the study
of the life and advancement of children. Formal lectures
on these studies are given, and local and general meetings are held
to advance the study of the question. The Paedologist is the offi-
cial publication of this association. {American Medicine, March
22, 1902.)
OVERCROWDING IN HOSPITALS FOR THE INSANE.
— In the recent report of the New York State Charities Aid Asso-
ciation data are given as follows: On October 1, 1901, the total
number of insane persons in public and private asylums was 24,-
354, an increase of 576 over the number of the previous year. In
the state hospitals alone, the increase over the year 1900 was 566.
At the present rate of annual increase, there will be, within the
next four years, an increase of 3,100 patients, for whom there are
at present no accommodations in the state hospitals. {American
Medicine, March 1, 1902.)
VIENNA PSYCHIATRIC AND NEUROLOGICAL
SOCIETY.
1. ON THE TOPOGRAPHICAL SIGNIFICANCE OF
ECHALALIA DR. A. PICK gave it as his opinion that in cases
of echolalia there must exist some impairment of the left temporal
lobe as well as defective inhibition.
2. TUBERCULOSIS AND ASYLUM TREATJ1ENT. — DR.
J. STARLINGER said that the growing dangers of the spread
of tuberculosis in asylums for the insane made it obvious that
special wards for the treatment of tuberculous insane should be
constructed, after the models of those built for simple cases of
the same disease.
ETIOLOGY OF PERIODIC PSYCHOSES. 165
3. TO THE ETIOLOGY OF PERIODIC PSYCHOSES — DR.
CLEMENS NEISSER read a paper on this subject. Dr. PILCZ
pointed out that cerebral affections, especially cerebral scars were
etiological factors in the production of periodic psychoses. In
4 out of 17 cerebral cases, periodic insanity was the immediate
sequence of cerebral apoplexy.
4. THE INFLUENCE OF FOOD ON THE COURSE OF
EPILEPSY. — DR H. SCHLOESS read a paper on this subject.
There is a divergence of opinions regarding the effect of food
on the course of epilepsy. Some claim that an exclusive meat
diet tends to increase the number of attacks, while others say that
an exclusive milk and vegetable diet cannot be said to materially
decrease the number of fits. The latter are decreased in number
by reducing the amount of table salt in the diet, according to the
method of Drs. Toulouse and Richet, bromide being administered
at the same time. Foods rich in acid and fat increase the number
of fits ; moderate use of alcoholic stimulants does not seem to have
any evil effects, the author claims. ( Wiener Klinische Rundschau,
Jan. 19, 1902.)
PRINCE AND PHYSICIAN.— Since Peter the Great, who practiced
the art of extracting teeth, there have been only two princes with the title
of M. D., both princes being of the house of Wittelsbach ; they are the Duke
Karl Theodor and the Prince Ludwig Ferdinand. One of them is an ocu-
list; both have established hospitals for charitable purposes on their lands
in the Tyrol, and they give their personal attention to the work. (Progres
Medical, Feb. 15, 1902).
PSYCHIATRY IN GOETHE'S WORKS.-DR. MOEBIUS furnishes
some more studies on the life of geniuses. The psychiatric features in
Goethe's works are not built haphazard, but were rather the results of
patient scientific study in the field of medicine. The names of physicians
and clinics are given with whom and where the poet studied gynaecology,
obstetrics, medicine and other branches of science. He had a horror of
insane asylums, but he had ample opportunities for the study of psychiatry
among those with whom he came in contact. Werther, for instance, was
built on the observations of a family pupil who had become demented ; the
poet's father died of senile dementia ; the poet said : "The world is so re-
plete with feeble minded and insane that it is not necessary to search for
them in the asylums." (Progres Medical, Feb. 15, 1902).
SOME FACTS RELATING TO THE ILLNESS AND DEATH OF
HEINE. — M. BAUDOIN. quoting from the memoires of the poet's friend,
who is a physician, Mme. la Comtesse F. von Gelden-Egmond, states that
Heine's father was a merchant and the mother was a distinguished woman.
He became the victim of locomotor ataxia, which eventually carried him to
his grave, in 1856. He suffered from ptosis of the right and left eye-lids,
which caused him much suffering during waking hours, when he had to
"lift the lids with his fingers" in order to be able to use his eyes; between
!66 BOOK REVIEWS.
the years 1837 and the date of his death, in 1856, he suffered numerous
physical sufferings,, between painful migraine, sciatica, an exhausting
cough, insomnia and a paralysis that confined him to bed during a period of
ten years.
Alphonse Daudet also died of locomotor ataxia. (Gaz. Medicate de
Paris, Feb. 15, 1902).
THE DEPOPULATION OF FRANCE.— In opening a meeting at
which the question of the depopulation of France was considered, M.
WALDECK-ROUSSEAU said, in part, that the large infantile mortality
was the gravest cause of depopulation; the small number of births should
also be considered and measures be taken for remedying the evil. During
the discussion that followed it was proposed to appoint several sub-com-
mittees, assigning them certain lines of work to further the question, but
only two sub-committees were appointed — one to study the birth rate and
the other the death rate. {Gazette Medicate de Paris, Feb. 15, 1902).
DEPOPULATION IN BERLIN.— The census for 1901 shows a pro-
gressively decreasing birth rate, beginning with the year 1876. The figure is
lower now than it was in 1814, when there was an obvious reason for the de-
crease. (Gazette Med. de Paris, Feb. 15, 1902).
BOOK REVIEWS.
CLINICAL LECTURES ON THE DISEASES OF THE
NERVOUS SYSTEM. Delivered at the Salpetriere Hospital, by
Prof. F. RAYMOND, Professor at the Faculty of Medecine of
Paris, Member of the Academy of Medecine. Five volumes, in
octavo, 70 francs.
The volumes contain the lectures delivered during the official
course of instruction on diseases of the nervous system, at the Sal-
petriere Hospital, Paris, inaugurated in 1882, by Charot, and com-
tinued, since 1894, by Professor F. Raymond; they comprise two
distinct series :
One deals with the presentation of the most interesting subjects
chosen among the out-door patients, who come for public consulta-
tions ; the examination is made before the auditors, and the lectures
are extemporaneous.
The second series consists of didactic lectures. While maintain-
ing himself within the clinical domain, the lecturer takes advan-
tage of the occasion offered him by the pathological cases before
him, to give his auditors exact notions on the etiology, symptoma-
tology, pathology, prognosis and treatment of the disease in ques-
tion. He contrasts the realities with which one is confronted with
the somewhat schematic conceptions of pathology, using, to this
end, not only his own personal experience, but all that, in the publi-
cations and experience of others, may throw light on the subject in
question.
BOOK REVIEWS. ^7
Such a method of teaching, necessitating as it does much labori-
ous preparation and much study, may claim to leave some lasting
trace, and to extend beyond the narrow limits of a hospital amphi-
theatre. Professor Raymond has therefore considered it a duty to
publish regularly the didactic lectures which he has delivered at
the Salpetriere Hospital since he succeeded to the Clinical Chair of
Diseases of the Nervous System at the Faculty of Medicine of
Paris. This publication consists of five large volumes; the last
appeared a few weeks ago.
These volumes constitute an entirely homogeneous work. They
comprise the most varied subjects ; we need only mention the ques-
tions which form the subject-matter of some of the principal les-
sons :
Isolated paralysis of the peripheral nerves; radicular paralysis;
polyneuritis (the study of this question, under its most varied
aspects, takes up twenty lessons) ; alternate paralysis (about ten
lessons).
Affections of the Cauda equina and the Conus terminalis
(the new ideas contained in these lessons have become classical) ;
Compression of the spinal Chord, by tumors, or as in Pott's dis-
ease; sub occipital Pott's disease; Progressive and chronic
ankylosing disease (a subject little known in literature) ; trau-
matic hemisection of the spinal chord; syphilitic myelitis.
Many lessons have been devoted to the study of the relations of
Acute ascending Paralysis of Anterior Poliomyelitis and of
Polyneuritis ; to the study of Progressive Muscular Atrophy, of
Friedreich's disease, of Tabes Dorsalis (and especially of the
treatment of the latter by re-education of the muscles), of Syrin-
gomyelia, of Diffuse Sclerosis (especially considered in its
latent forms), of the sensory disorders observed in the last three
affections ; to the study of Little's disease, of Thomsen's disease, of
Lateral Amyotrophic sclerosis, and of Bulbar Paralysis, of Pseu-
dobulbar Paralysis, of 0 phtalmo pie gia in its relation to Locomo-
tor Ataxia, of circumscribed lesions of the region of the Corpora
ouadrigemina, of very curious cases of hereditary atrophy of
the Papilla, of cases of juvenile General Paralysis; to the study
of diffuse tubercular meningitis, of Sclerodermia, of infantile
my xo edema and its treatment by thyroid medication.
Partial epilepsy on one hand, and cerebral tumors on the
other have formed the subject matter of a number of systematic
lectures, in which one will find exposed, in clear and concise terms,
all that is known of the topographical diagnosis and treatment of
the lesions referred to. Incidentally, the author sets forth the
actual states of the doctrine of cerebral localizations, and has
l6g BOOK REVIEWS.
gone into the details of the topography of the cortical centres of
sensibility.
Hysteria has been studied generally in its relations to the dif-
ferent affections of the nervous system, and especially in a number
of its most interesting manifestations; systematic contracture;
hystero-traumatism ; verbal deafness; myoclonia, etc.
Other lessons, for instance those on heredity in nervous pathol-
ogy, those on ambulatory delirium, show us how clinical study can
elucidate questions which have hitherto belonged to the domain of
medical philosophy and psychology.
Finally, the historical evolution of neuropathology has been
exposed in a pleasing manner in the first lectures contained in
the first volume, under the following titles : the Work of a Man
(Charcot) ; the Work of an Epoch.
The text of these five volumes, written in a clear and easy style,
an exact counterpart of the author's oral teaching, has been illus-
trated by hundreds of figures and numerous colored plates.
Professor Raymond's work will not only interest specialists; it
must be studied by the general practitioners and surgeons who are
desirous of keeping abreast of the times in this all important sec-
tion of pathology.
The five volumes, by subscription, 70 francs, post free.
Price of each separate volume: Volume I, 10 francs; volume II,
18 francs ; volume III, 20 francs ; volume IV, 15 francs ; volume V,
16 francs.
Octave Doin, Publisher, 8 Place de l'Odeon, Paris.
N. VASCHIDE and CL. VURPAS. PSYCHQLOGIE DU
DELIRE DANS LES TROUBLES PSYCHOPATHIQUES.
Masson et Co., Paris. Price 2 fr. 50. The names of the two
authors of this volume are quite familiar to the psychologist as well
as to the psychiatrist. The thoroughness and originality of their
scientifique contributions have placed these authors on a high
scientific level, and this volume bears the general characteristics of
their other works — unhampered search for the explanation of the
psychology of delirium. A thorough expose is made of the concep-
tions of what constitutes delirium, as expressed by leading authors
in their classic works, and the conclusions drawn from that expose
are made the bases of elucidation of the question of what consti-
tutes the psychology of delirium. It is concluded that the various
psychic processes are similar in the normal and the morbid states ;
they differ in degree and quantity, however, this difference alone
marking the borderland between the cerebration of the sound and
the unsound mind. The volume has 190 pages.
BOOKS AND PAMPHLETS RECEIVED.
VORLESUNGEN UEBER DIE PATHOLOGISCHE ANATOMIE
DES RUECKENMARKS. Unter Mitwirkung von Dr. Siegfried Sacki,
Nervenarzt in Muenchen. Herausgegeben von Dr. Hans Schmaus, A. O.
Professor U. I. Assistant am Patholog. Institute in Muenchen. Mit 187
Teilweise Farbigen Textabbildungen. Verlag von J. F. Bergmann. Wies-
baden, 1901.
RECHERCHES CLINIQUES ET THERAPEUTIQUES SUR L'EP-
ILEPSIE, L'HYSTERIE ET L'IDIOTIE. Compte-rendu du service des
enfants idiots, epileptiques et arrieres de Bicetre pendant l'annee 1900.
Par Bourneville, avec la collaboration de MM. Crouzon, Dionis du Sejour,
Izard, Laurens, Paul-Boncour, Phillippe et Oberthur. Vol. XXI, avec 19
figures dans le texte et XI planches. Progres Medical, 14, rue des Carmes,
and Felix Alcan, 108, Bd. St. Germain, Paris, 1901.
DIE KOERPERLICHEN ERSCHEINUNGEN DES DELIRIUM
TREMENS. Klinische Studien von Dr. August Doellken, I. Assistentarzt
der Psychiatrischen und Nervenklinik. Mit Zahlreichen Figuren. Verlag
von Veit und Co., 1901, Leipzig.
LA MIGRAINE ET SON TRAITEMENT. Prof, Paul Kovalevsky,
M. D., Membre hon. de la Societe de Medecine Mentale de Belgique, de
Niederlande, Corresponding Member of the New- York Academy of An-
thropology, Membre de la Societe Medico-Psychologique de Paris, de Lon-
dres, dTtalie, etc.,, etc. Vigot Freres, 1902, 23 Place de TEcole de Mede-
cine, Paris. Tout droits reserves.
MONOGRAPHIC CLINIQUES NO. 29., PUBLIE LE 5 FEBRIER,
1902. Les ponctions Rachidiennes Accidentelles et les Complications des
Plaies du Rachis par Armes Blanches sans Lesions de la Moelle. Par le
Dr. E. Mathieu, Medecin Inspecteur de TArmee, Ancien Directeur et Pro-
fesseur du Val-de-Grace. Masson et Co., Paris, 120, Bd. St. Germain,
Paris.
SURPA UN CASO DI EPILESSIA TARDIVA IN UN ALIENATO,
pel Dott. Giuseppe Muggia.
REMARKS ON THE CZOLGOSZ CASE AND ALLIED QUES-
TIONS, AS PRESENTED BY DR. TALBOT. By E. C. Spitzka, M. D.,
New York.
REPORT OF THE COMMISSIONER OF EDUCATION, U. S. A.,
1899-1900, Vol. 2.
\sJr
Vol. II.
1a\\y\^.
No. 4-
The Journal of
Ment
Subscription Price : — $2.50 per annum*
Single Copies, 50 cents.
Edited by Louise G. Robinovitch, B. ts L., M.D.
Editorial Board
Dr. V. MAGNAN, Dr. A. JOFFROY, Dr. F. RAYMOND (Paris), Dr. CHAS. K. MILLS (Phila.),
Dr. JUL. MOREL (Belgium), Dr. E. REGIS (Bordeaux), Dr. G. CESARE FERRARI, Editor Rivista
Sperim. di Fren. (Italy).
Contributors* Staff
ALBANEL, L., LL. D., President Society Family Patronage (Paris); BAILEY, Dr. P. (New York);
BAJENOW, Dr., (Moscow); BECHTEREW, Prof. (Russia); BERILLON, Dr. Edgar (Paris);
BLEULER, Prof. E. (Zurich); BLIN, Dr.; BOISSIER, Dr. F., BOURNEVILLE, Dr., Chief Physi-
cian Bicetre Asylum, Editor Progres Medical; BRAESCO, Dr. Al. N. (Roumania) ; BRIAND, Physician
to the Asylums of the Seine; BALLET, Prof. G., Faculty of Medicine (Paris); CHATTERJI, Mr. J. C.
(Bernares, India); CLAPAREDE, Dr. Ed., Editor Archives de Psychologie (Switzerland); CROCQ,
Prof., Editor Journal de Neurolgie (Belgium) ; DRILL, Dimitri, LL. D., Jurist Ministry of Justice
(Russia) ; DEKTEREW, Dr. W. de, Member Municipal and General Council (Russia) ; DAGONET, Dr. ;
FAURE, Dr. Maurice; FERRI, E., LL. D., Deputy (Rome, Italy); FAREZ, Dr. Paul; GREIDENBERG,
Dr. B. S. (Russia) ; GARNIER, Dr. P., Expert at the Tribunal (Paris) ; JANET, Dr. (Paris) ; KOPOS-
SOW, Dr., Superintendent Simbirsk Asylum; LALANNE, Dr.; LANGELAAN, Dr. J. W. (Holland);
LEGRAS, Dr.; LEGRAIN, Dr.; LOURIE, Ossip, Ph. D. (Paris); MARRO, Prof., Dir. "Annali di
Freniatria" (Italy); MARIE, Dr. Auguste, Chief Physician Villejuif Asylum; MARINESCO, Prof. G.
(Roumania); MARTIN, Dr. E. (France); MEDICI, Dr.; MacDONALD, Dr. A. E., Superintendent
Manhattan State Hospital (New York); NAMMACK, Dr. Ch.; NEISSER, Dr. CLEMENS, Chief
Physician of the County Asylum, Leubus (Germany); OBICI, Dr. (Italy); PETERSON, Dr. F., Com-
missioner in Lunacy, State of New York; PIERON, Dr. H., Preparateur Laboratory Experim. Psych.,
School of Higher Studies (Villejuif); PHILIPPE, Dr. CI.; REGNARD, A., Ministry of the Int.,
(Paris); REIS, Dr. Mello (Brazil); ROBERTSON, Dr. F. W., General Superintendent Elmira Reform-
atory; REY, Dr. Philippe, Superintendent Public Asylums (Aix) ; RITTI, Dr. Ant., Chief Physician
Charenton Asylum; SEMELAIGNE, Dr. Rene; SEMIDALOW, Dr. B. (Russia); SERIEUX, Dr. P.
(France); SERGI, Prof. G. (Italy); SINANI, Dr. B. N. (Russia); SERBSKI, Dr. V. P. (Moscow);
SNELL, Dr.; SOUKHANOFF, S., PrKat. Docent, Univ. Moscow; SPITZKA, E. A. (New York);
STOENESCU, Dr. N. (Roumania) ; TATY, Dr. (France) ; TSCHISCH, W„ Prof. (Russia) ; TREVES,
Dr. Marco (Italy); TOULOUSE, Dr. E., Chief Physician Villejuif Asylum, Director Laboratory Exper.
Psych., School of Higher Studies; TRUELLE, Dr.; VAN DEVENTER, Dr., Dir. Meerenberg Asylum,
Holland; VAN HAMEL, G. A., Prof. Criminal Law, Univ. Amsterdam; VURPAS, Dr. CI., Asylums of
the Seine; VAN GIESON, Dr. Ira T.; VALLON, Dr. Physician to Ste. Anne, Expert at the Supreme
Courts (Paris); VASCHIDE, Dr. N., Chef des Travaux, Laboratory Exp. Psychol. (Paris); VOISIN,
Dr. Jules, Physician to the Salpetriere (Paris); WINKLER, Dr. C.,Univ. Amsterdam.
STATE PUBLISHING COMPANY
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TABLE OF CONTENTS.
LEADING ARTICLES.
A Study of the Emotions', Prof. A. Marro 169
On the Question of Dementia Praecox, Prof. Serbski 175
The Psychoses with Delusional Interpretation as a Basis, Drs.
Serieux and Capgras 183
The Genesis of Epilepsy Clinically Considered. The Pathology, Pro-
phylaxis and Treatment of Epilepsy, Dr. Robinovitch 187
EDITORIAL.
The "Abstract" Idea 196
TRANSLATIONS AND ABSTRACTS OF CURRENT LITERATURE.
On Alexia 198
On the Treatment of Epilepsy by the Toulouse-Richet Method 199
On the Light Reflexes 200
Extracts from "Crime dans la Famille" 204
Cruelty in Children 206
The Treatment of Defectives 207
Hallucinations and Illusions 208
Traumatic Encephalitis 210
Researches in the Comparative Globular Resistance in the Aged, Nor-
mal and Insane Subjects : 211
Localization of the Motor Nuclei in the Spinal Cord of Man 211
Surgical Stump Hallucinations' 212
A Case of Ursemic Polyneuritis 212
Pneumococcus Abscess of the Brain 213
The Cerebral Localization 214
Intestinal Tuberculosis of the Insane 215
Aphasia <....). 215
Lumbar Puncture for Cephalalgia 216
XIV. International Congress of Medicine 217
The Death of Goethe. His Descendants 219
BOOK REVIEWS.
Vorlesungen Ueber die Pathologische Anatomie des Rueckenmarks.
Sacki 221
Soudebnaja Psychologuia, Professor Serbski 222
Recherches Cliniques et Therapeutiques, Bourneville 222
Les Ponctions Rachidiennes Accidentelles, Mathieu 223
La Migraine, Prof. Kovalevsky 223
Congres' Int. d'Antrop. Criminelle 223
L'Etat Mental des Parricides, Dr. Asselin 224
Books and Pamphlets Received 3d cover
The Journal of Mental Pathology.
Vol. II. MAY, 1902. No. 4.
A STUDY OF THE EMOTIONS.
BY DR. A. MARRO, Prof. University of Turin, Italy.
The satisfaction of our desires and the failure to satisfy them is
expressed psychically by conditions of joy or distress, respectively.
Lange gives the following schema expressive of the psychic versus
the physical manifestations : ( 1 )
CONTRARINESS — slackened voluntary innervation.
DEPRESSION — slackened voluntary innervation plus vascular
constriction.
FRIGHT — both the foregoing plus spasm of the organic
muscles.
IMPATIENCE — heightened voluntary innervation plus spasm
of the organic muscles.
JOY — heightened voluntary innervation plus vascular dilation.
ANGER — heightened voluntary innervation plus vascular dila-
tion, plus disordered muscular movements.
From the facts here stated it can be judged that moral pain can
be followed by fatal consequences when the accompanying physi-
cal manifestations are of an exaggerated nature. Fright and
despair, for instance, are two psychic conditions in which the cor-
responding physical reactions vary to a marked degree, and may
become quite harmful in a condition of prolonged despair. In
fright, there is always a tendency to reaction by the act of self
defence ; but in despair reaction from the physical derangement is
rather delayed by reason of the condition of resignation that may
take place. It is obvious that the condition of stupor is accompa-
nied by a still more marked tendency toward a continuance of
whatever physical derangement may exist as a consequence.
Clinically, these facts have their importance. Thus, melancholia
with agitation presents far more hope for a speedy or slow recov-
ery than does the form of this disease characterized by stupor.
Of eighteen melancholiacs with agitation admitted to my wards,
one was cured within the course of a month, three were cured
within the lapse of two months, six within five months, and two
give every hope for their recovery within the near future. The
aspect of hopeful recovery is quite different in the stuporous mel-
ancholiac. Of fourteen such cases admitted to my wards, the
iy0 STUDY OF EMOTIONS.— Prof. Marro.
speediest recovery took place within the course of five months in
one case and in six months in another, and all the remaining cases
are still under treatment.
The clinician should delve a bit more carefully into the laws of
reaction if he wishes to understand his cases more clearly. It may
be accepted as a general rule that moral pain is an indication of the
want of psychic reaction, of the existence of organic reaction alone,
which results in certain physical and chemical actions. The first
effect of fright is that of constricting the peripheral vascular sys-
tem, and the first sensory impression during fright is that of cold ;
the vascular constriction may extend not only to the arteries but
also to the veins ; cardiac paralysis sometimes takes place under
such conditions.
The lo wered temperature is not only a subjective phenomenon
but may be reproduced experimentally. I have obtained a lower-
ing of temperature of four degrees C. in a rabbit, after it has been
subjected to a mechanical rotary centrifugal movement on a wheel.
Another rabbit showed a lowering of temperature of from 0.02 to
0.2 degrees from the effect of fright when its paw was dipped in
water of a temperature of 60 degrees. In addition to the lowering
of the temperature, consequent on the changes of the irrigation of
the blood, urinary changes also take place after an emotion of fear.
The urine of insane patients with terrifying hallucinations contains
a marked quantity of acetone (2). Experimentally, I have also
succeeded in finding an exaggerated acetonuria in an eagle ( ?)
which struggled in its cage for some hours. A similar urinary
change could be observed in rabbits which had been subjected to
rotary movements on a wheel ; I have also found an increased ace-
tonuria in a dog subjected to fretting: the animal was placed on
the cornice of a window, on the second story, and left there for a
period of some hours ; when released, the dog trembled and re-
fused to eat meat that was offered to it ; several hours passed
before the animal resumed its normal behavior. The increased
acetonuria was expressed by some 0.0124 grams per 100 cc. above
the normal.
Bichat reports a case of a woman who was affected by the sight
of her husband engaged in a perilous sword fight ; she nursed her
two-months old baby soon after this emotion; the child, who was
in perfect health before sucking the mother's milk, began to trem-
ble and died a few minutes after. There are cases on record which
show that maternal impressions of a frightening nature during the
early part of pregnancy caused the birth of monsters.
It may be said that many psychoses and neuroses make their
appearance after some fright in those predisposed to the maladies.
STUDY OF EMOTIONS.— Prof. Marro. iji
This fact must not be overlooked in clinical work, where we should
closely account for every determining or exciting cause, whether
of psychic or bio-chemical nature. I have a case on record illus-
trative of the effect of fright on the predisposed. A young man
was threatened angrily by his employer; when the menace was
resumed, the youth ran out into the street and started homeward
at a fast pace, gesticulating in a strange manner. On beholding
his family, he became still more frightened and attempted to run
out of the house. He was taken to the asylum in a condition of
marked excitement and remained under that spell during a period
of four months (3). I firmly believe that the preachers who are
lavish in vivid descriptions of the horrors of "perdition" and of
the cruel sufferings that await "sinners" are responsible for many
cases of insanity which would have remained in abeyance had it
not been for the exciting influences of these phillipics. I have
known cases, not only of epilepsy, but also of general paralysis that
set in subsequently to fright. In one such case of a young lady, with
no morbid hereditary taint, four individuals presented themselves
to her, dressed in white surplices; the wierd sight of the figures
robed in white frightened her into unconsciousness. Choreic
movements set in when she regained consciousness and these were
followed by symptoms of paralytic insanity, which soon caused
her death. Another girl was frightened by an individual who
introduced himself into her room and attempted to abuse her. She
developed choreic movements after this incident and a mental dis-
turbance with febrile movements set in and caused her death. The
earthquake of 1887 was followed by many fatal cases of insanity
of both sexes. In my private practice I have known many cases
of insanity to follow the fright of being bitten by a dog, whether
the animal was or was not rabid. In such cases, the patient is
generally under the influence of the fear that the dog was rabid
and the delirium pivots about that emotional thought. One conva-
lescent melancholiac, whose disease was brought on by the fright
of having been bitten by a dog, had a sudden relapse of his psychic
ailment from having noticed a dog while looking out of the win-
dow of the ward.
As is well known, the organic disturbances found in melan-
cholia are mostly hepatic dilation, abdominal vascular plethora,
and a lowered temperature with a cold skin livid in color. The
languor and abulia of the melancholiac are due, partly, to the vas-
cular disturbance.
According to Mantegazza, the emotion caused by pain is accom-
panied by a lowering of the temperature. As for the bio-chemical
changes found in the melancholiac, I reported the results of my
172 STUDY OF EMOTIONS.— Prof. Marro.
researches on that subject some years ago (4). I demonstrated
that the phosphoric acid combined with the alkaline metals and
that the sodium and potassium salts were diminished, while the
combinations of the earthy alkaline salts, calcium and magnesium,
were increased, that the sulphuric acid is likewise diminished in
the urine, and that the fatty acids, acetic and formic, are con-
stantly present.
The immediate effects of the more intense forms of pain may
sometimes prove fatal. Mantegazza reports a case of a mother
who, stricken with grief at the death of her only daughter, refused
to leave the room of the dead, keeping close to the corpse. When
she heard the noise of the approaching undertakers, who were to
remove the body, she fell to the ground and expired (5).
It is related that during the combat against the Turks, during
the siege of Buda, Raisciac di Svezia and others, who watched a
heated engagement and its termination, ran up to the wounded to
extend assistance. As he approached the sufferers, Raisciac noticed
the upturned face of his son's body. The father fell dead without
uttering a word (6).
Fright of a marked degree may give results similar to those
brought about by pain. The students of an Italian convent planned
and executed an elaborate hazing scheme on one of the supervis-
ors, who was unpopular because of his pedantic enforcement of
the rules of the institution: the man was taken into a chamber,
which, he was told, was a tribunal; judges sentenced him to death
and proceeded to execute decapitation, which was the mode of
death decided on in his presence. At first the subject took the
matter as a joke, but when one of the disguised students sprinkled
cold water on his neck, the unfortunate supervisor fell dead, the
impression conveyed to him being that he was being struck with a
sharp hatchet.
Delpesch reports that before chloroforming a patient who was
to have an incision on the neck, he traced the direction of the pro-
posed incision on the patient's skin with the blunt edge of the
instrument. On feeling the contact of the steel the patient fainted
and died (7).
The consequences resulting from physical and moral pain are
brought about in a similar manner anatomically. In the case of
one patient, who died from the effects of a blow on the abdomen,
it was found, on the autopsy, that the heart was empty,
while the liver, spleen, kidneys and abdominal vessels were en-
gorged.
Golzche's experiment in this respect is classical ; a frog's heart
is exposed to view and the abdomen is hit with a hammer; the
STUDY OF EMOTIONS.— Prof. Marro. ij$
heart is seen to empty itself and stop beating, while the abdominal
organs become filled with blood.
I have already mentioned that in the melancholic conditions the
abdominal viscera are almost always engorged.
Moral pain under its various forms is a potent factor in the eti-
ology of mental diseases, especially in women. The expansive
emotions, on the contrary, favor a. salubrious condition of all the
vital functions; but when taking place to an exaggerated degree
they may provoke dangerous consequences. I recall a striking
example of this kind as illustrated by such emotions in a dog. My
father's dog, which was unusually attached to him, was stolen.
The animal was traced to its new quarters, and as my father
approached the dog, it seemed overcome with joy at seeing its
master ; it sprang to his shoulder and then fell to the ground as if
dead ; several minutes elapsed before the dog regained conscious-
ness.
Psychically, an expansive emotion may sometimes cause the
manifestation of an insane act. The story of Archimedes is well
known: when he made the discovery that made him cry out
"Eureka" he ran out into the street naked.
The exhilarating effect of music is well known to the soldier,
and many a battle has been won through the subtle encouragement
derived from martial strains in time of dire dejection.
The emotion of wrath is important from a sociological stand-
point : one might say that this form of emotion enters into every
criminal act. The greater passions, ire, vendetta, jealousy, and
furor are derivative emotions of wrath. Anatomically, the traces
of such habitual emotions are seen in the presence of arterio-
sclerosis ; the epileptic and apoplectic are the most frequent bear-
ers of these forms of emotion. Traces of the bio-chemical emo-
tions can generally be found in the urine after the end of the
psychic spell. Niemeyer reports a case of a diabetic who was
apparently free from the usual disturbance of his disease. He was
angered by some slight incident and suddenly became furious.
The urinary analysis, of a specimen, taken aftre the spell was over
showed that a recurrence of the disease had taken place. The
period of puberty is noted for showing frequent occurrences of
spells of anger. The phenomenon is possibly due here, to the new
biochemical action connected with the spermatic secretion.
I have had occasion to speak of the occurrence of frequent spells
of anger during the period of puberty in connection with crimi-
nality. The criminal subjects seem to lack the power of self-
control, particularly during the period of puberty, when their
viciousness reaches its maximum height. I have had occasion to
174
STUDY OF EMOTIONS.— Prof. Marro.
observe a young criminal subject who became angry at a remark
made to him, and, frenzied, threw himself from a window on the
second floor of the prison. When picked up, his skull was found
to have been fractured. Every psychiatrist is familiar with the
explosive passions of the criminal : they shriek, assault, tear their
clothes, break the furniture and commit other acts of violence on
the slightest provocation.
The conditions of frenzy in the maniac and alcoholic are mat-
ters of great interest and should receive closer attention ; it will
pay to study them.
REFERENCES.
i. LANGE. Les emotions, p. 82, 1895.
2. A. MARRO. L'acetonuri e la paura. Giorn, della R. Ac. di Med.,
Torino, 1889.
3. The case was subsequently brought to court and the Bench accepted
my view that the employer was guilty of having precipitated the onset of the
disease in the young man.
4. A. MARRO. Ricerche analitiche sulle orine di persone lipemaniache.
Giorn. della R. Ac. di Med., Torino, 1887.
5. MANTEGAZZA. Fisiologia del dolore.
6. ANGELO MOSSO. La paura, p. 246, Milano, 1884.
7. BROUARDEL. La mort et la mort subite, p. 351, Paris, 1895.
ON THE QUESTION OF DEMENTIA PRECOX.
BY DR. VLADIMIR SERBSKI, Privat-Docent, University Moscow.
i. — The most valuable additions, within the last ten years, to
the knowledge of mental forms, are those relating to the differ-
entiation between paranoia and amentia. To-day, considerable
time is given to the consideration of another form, — mental en-
feeblement, — particularly the variety which has no definite gross
anatomical basis. This question is intimately connected v/ith
Kraepelin's views on it, and many contest the logic of the accept-
ance of that form as he describes it; Morel (i) was the first to
term the disease demence precoce. Before accepting Kraepelin's
views, it is well to consider all terminal states of the psychoses
which do not result in a complete recovery : under such considera-
tion, Kraepelin's form, — dementia precox, becomes a matter of
debate, as we have been accustomed to apply the term dementia
secundaria scu consecutiva to that form of disease which installed
itself as a terminal end after the course of some psychic disturb-
ance. This point of view was not taken into consideration at the
Paris International Congress, although distinguished men, such
as Ziehen, Marro, Voisin and others, were there to discuss the
psychoses of puberty. The views advanced in this discussion
were limited to the well known conception that varied psychic dis-
turbances may take place during that period of life; the enum-
erated abundance of these forms, however, swallowed up the
theme of dementia praecox. An important feature during these
discussions was that neither the readers of papers nor the dis-
cussers seemed to be inclined to compare their views on this
form of disease with that of the Heidelberg professor. Yet, to
Kraepelin belongs the merit of having familiarized us with de-
mentia prcecox, although we look on it in a different light from
that in which he has presented it to us. Exaggerations of facts,
analogous to that seen in Kraepelin's definition of the disease here
considered, plays an important part in the history of our knowl-
edge: our attention is thereby attracted and the matter is sub-
sequently relegated to the place where it properly belongs.
When attempting to reduce the somewhat wide limits of pri-
mary dementia, the first point that forces itself on our attention is
176 DEMENTIA PRECOX.— Prof. Serbski.
that regarding the advisability of retaining in our classification
the group of dementia secundaria. The latter presents, no doubt,
a somewhat artificially chosen group, which embraces unfavor-
able terminations of a great variety of psychic disturbances. A
point in favor of the retention of this group of forms may be the
one, as some would have it, that every termination of a given
disease is inherent to that very disease and can even be predicted ;
that the fundamental origin of diseases which end in terminal
dementia differs from that of diseases which end in recovery. Con-
sequently, the diseases which lead to psychic disintegration should
be strictly separated from those which do not lead to such an end.
From this point of view, however, secondary dementia, as a termi-
nal condition of various pathological processes, does not exist ; at
the root of those cases, which we say end in terminal dementia,
there exists a process sui generis, which fatally leads to dementia
(verbloedungsprocess), and for this reason they should be grouped
by themselves.
I consider the above reasoning quite erroneous, because one
and the same disease may lead to various and different termina-
tions. If, indeed, the end of a given disease were prearranged by
fate, it would be useless for us to devote our time to treating such
diseases. Whereas, we know from experience that surround-
ings, circumstances and individual resisting power play an im-
portant part in the termination of these diseases. Finally, the
intensity of the disease itself also plays an important role, which
can in no wise be predicted. The combination of all these con-
ditions limits our predictions of the end, making it quite indefinite
and approximate.
If, therefore, one and the same disease may lead to various ter-
minations, it is evident that the grouping of diseases according to
their terminations, and the use of the latter as a fundamental in-
dex for classification, is absolutely untenable. No one, for in-
stance, would base the diagnosis of cerebral hemorrhage on the
possible eventuality of a permanent hemiplegia; nor would we
make the diagnosis of a urethritis dependent on a subsequent
stricture or albuminuria. In view of these considerations, I con-
sider Kraepelin's method of limiting amentia erroneous. His
views on this subject are particularly unacceptable, because the
prediction can be based neither on the onset, course, nor the eti-
ology of the disease.
The statement regarding the prognosis of maniaco-depressive
insanity (2) is equally erroneous. We have all seen cases of
mania and melancholia that made us give a favorable prognosis,
but which ended in chronicity and even mental impairment.
DEMENTIA PRECOX— Prof. Serbski. 177
To repeat what has already been said on this score, we are forced
to ask: is there a fundamental difference between the processes
during the course of a disease which ends in dementia and the
processes of a disease which ends in recovery? We repeat this
question only to answer again that we have no basis on which to
found a statement. The clinical manifestation seems to be
identical in both cases, and we cannot discover any indication in
the direction of this or that prediction ; but we must not allow the
varying terminations to influence us in making ungrounded pre-
dictions.
II.-r— On examination of Kraepelin's dementia prcecox, one is
struck with the absolute impossibility of explaining what consti-
tutes the fundamental trait of this pathological group and what
is considered the common element in that chaos of varied clinical
manifestations. True, the indicated common trait is the men-
tal enfeeblement characteristic of itself; but it is immediately
added that this issue is not necessarily invariable, but that it is a
frequent form of termination (3). The general characteristics
of this disease, as they are given, impress one as being markedly
vague in the symptomatology and blurred as a clinical description.
The very qualifying adjectives of the signs of this disease
("generally," "often," "not infrequently," "sometimes," etc.)
make us infer that the majority of these attributes are not essen-
tial parts of the picture of the disease. The importance that is
ascribed to the manner of shaking hands (4) can only be ex-
plained on the ground of invalidity or even of absence of more en-
during signs. Even signs relating to disturbance of attention
and impairment of judgment are said to be not invariable, but
conditional. Tschisch and Daraszkiewicz (5) count the disturb-
ance of attention among the essential traits of hebephrenia;
Kraepelin, however, states that the subjects suffer from that dis-
turbance either not rarely or not at all ; that this can be seen from
the fact that they exhibit a certain amount of curiosity; that the
power of judgment often remains intact when relating to things,
the knowledge of which was acquired in early life; not infre-
quently, the patient is even aware of his being ill. When we
learn that Kraepelin classes also chronic delirium (of Magnan)
with dementia praecox, it becomes apparent that disturbance of at-
tention and of judgment is not a sign inseparable from the picture
of dementia prsecox. Thus, in the intellectual sphere of this dis-
ease we find no specific guiding signs. We find, according to
his indications, as distinctive elements, more or less mental stupor
(which is common to many psychic disturbances), which, in its
turn, changes volitional activity. The change of volitional activ-
178 DEMENTIA PRECOX.— Prof. Serbski.
ity, as indicated, is open to criticism, if we try to apply that change
to cases of mental disturbance known as delirium of persecution ;
in this disease neither mental activity nor psycho-motor phe-
nomena show any alterations during a long period of time from
the beginning of the course of the disease (if we diverge from
Kraepelin in classing among the latter phenomena neologisms).
In his "Introduction to Psychiatry," Kraepelin gives as funda-
mental signs of dementia prsecox mental stupor, disinterestedness
in surroundings and activity. So that the conception of dementia
prsecox is reduced to that of acquired mental enfeeblement, in
which the intellectual sphere and volitional activity are impaired.
On bringing together primary and secondary dementia, Kraepe-
lin is again extremely vague in his sketches of the respective dis-
eases. It appears that dementia prsecox, as he understands it,
does not always end in dementia: the variety termed "hebe-
phrenia" may yield 8 per cent, of recoveries and the catatonic form
may even have 13 per cent, of recoveries. One cannot help un-
derscoring the very singular contradiction relating to the above
cited facts in connection with a disease, the fundamental charac-
teristic of which is dementia ; if recoveries take place as above
stated, then have we a form of dementia without dementia.
One is also astonished to learn from the same source that de-
mentia psecox may develop at any period of life, even at the age
of 40, 50 and 55 years.
No matter how we consider this disease, it is characterized by
two fundamental distinctive traits: 1, — disintegration of the psy-
chic organization, i. e., irreparable terminal mental enfeeblement,
dementia, and, 2, the onset of this dementia during a period, when
the psychic organization has not yet reached complete develop-
ment. Disregard of these limiting traits is quite equivalent to
disregard of other characteristic traits, — in senile dementia, for
instance, and arbitrary reasoning of that sort might as well lead
us on to an assertion that senile dementia is curable and that it
may also set in between the ages of 20 and 30 years.
As is known, Kraepelin distinguishes three varieties of de-
mentia prsecox: Hebephrenic, catatonic and paranoidal. In the
description of the hebephrenic variety, Kraepelin follows Dar-
aszkievicz, enlarging Hecker's characteristic description with
"grave forms" of hebephrenia, which end in marked dementia. As
regards the catatonic forms, I am pleased that Kraepelin classes
them with dementia prsecox. Long before he did so, I drew at-
tention to the close connection between catatonia and hebephrenia
and said that some of the cases of catatonia should be classed with
dementia prsecox (6). I did not consider, however, that it was
DEMENTIA PRECOX.— Prof. Serbski. 1 79
right to class all cases of catatonia with dementia praecox. Cata-
tonia, as a symptomatic group, may be found during the course
of various mental disturbances, and is found, also, in cases of
amentia. This fact is probably the reason why there are so many
divergences of opinion among authors regarding the cause, char-
acteristics, termination, etc., of catatonia.
The introduction of paranoidal forms into this group is quite
acceptable; but it is absolutely erroneous to place here chronic
paranoia with hallucinations (typical delirium of persecution) and
there seems to exist no excuse for such an arbitrary grouping (7).
It is possible that in the near future we shall become acquainted
with the relation to this group of amentoid, melancholoid, manioid,
etc., dementias, as dementia may become the closing scene of other
than delirious mental states. For the present, it is not quite
clear in what relation this new variety stands to delirious attacks
and the more prolonged psychoses of the degenerate, which end
in complete recovery.
The theory of auto-infection through the sexual organs is not
based on any positive data and is inapplicable to the delirium of
persecution and to mental diseases of adult age. The theory loses
in its generalization, failing ot unify the clinical forms on the
basis of their pathogenesis.
Kraepelin is credited with having introduced a so-called new
method of clinical analysis, which strives to bring to the fore
objective signs, as such are the leading indices in dementia prsecox
(automatism, negativism and stereotypias).
I think that such an assertion is based on a misunderstanding.
This can easily be seen from the fact that the above mentioned
signs are not absolutely necessary accompaniments of the dis-
ease; besides, these signs may be found to exist, in even a more
marked degree, during the course of various other mental forms
(amentia, hysteria, progressive paralysis, etc). The main point
is that these signs cannot b considered as constituting absolute
objective indices of a given disease; the diagnosis cannot be made
on the strength of their presence, as they may accompany many
diseases. The correlation of negativism and stereotypias can be
established in many forms of mental disturbance, showing that
the signs depend on an impaired intellectual sphere (8). Esquirol's
typical case is illustrative in this respect ("Budge and you are
lost"), showing that motor resistance may be due to a command-
ing hallucination. Kraepelin's assertion, therefore, given in ex-
planation of similar phenomena ("every tendency is soon replaced
by one more intense"), seems less intelligigble than are the expla-
nations found in clinical cases.
180 DEMENTIA PRECOX.— Prof. Serbski.
Thus, we must admit that Kraepelin's views have not advanced
our knowledge of dementia praecox ; they have, on the contrary, in-
troduced a series of complex misunderstandings. We are forced to
consider his dementia praecox as an artificial creation of a group,
which comprises most diverse pathological processes. There is
an absence of a fundamental point of view, — a contradiction be-
tween the definitions, and the disease is confounded, in the same
series, with secondary dementia, amentia and chronic paranoia.
III. — I have endeavored in this report to call attention to
Kraepelin's views. For reason of lack of space here, I limit my-
self to this negative side of the question, giving, in general terms,
my own point of view on the subject. The report will be pub-
lished in extenso in the "Journal S. S. Korsakova," Nos. 1-2, 1902.
Dementia praecox should comprise only those forms of mental dis-
turbance the fundamental traits of which are : 1, — the onset of dis-
ease taking place not later than the adolescent age, and 2, — rapid
development into a condition of mental enfeeblement, in various
degrees. As the course of this disease is various, according to
cases, dementia praecox may be divided into three varieties.
(a.) In some cases, it is impossible to trace any acute period of
the disease ; there seems, on the contrary, to be a slow and progres-
sive psychic disintegration of various degrees.
(b) Other cases seem to be characterized by the manifestations
of acute symptoms of various forms. To this group belong sev-
eral varieties, although they cannot be distinctly circumscribed, as
they may, sometimes, merge one into the other. In some cases,
Hecker's form of hebephrenia seems to predominate, while in
others, the catatonic form is most in evidence; in a third group,
finally, the delirious aspect (paranoidal form) seems to pre-
dominate. At times, however, it is impossible to divide one from
the other.
(c.) In some cases, dementia praecox may be considered as a
secondary manifestation, i. e., secondary to some acute psychic dis-
ease (amentia, dementia acuta.) An acute psychic disease at that
period may end in recovery, leaving a slight psychic defect; on
such an impaired basis may take place either an acute exacerbation
or a relapse of the disease, leaving every time a more and more im-
paired psychic condition (dementia secundaria progressiva) (9).
Physical signs would be very valuable in the diagnosis of de-
mentia praecox; unfortunately, we have no reliable signs to that
end. Kraepelin indicates increased reflexes and inequality of the
pupils as guides, but these are not invariable accompaniments of
the disease ; they only indicate the gravity of the affection, and are
found in certain forms of amentia. Similar remarks are applicable
DEMENTIA PRiE COX.— Prof. Serbski. 181
to the various convulsive manifestations in the early stage of the
disease (10). At present, our main guide is the patient's age, the
characteristic course of the disease, and some particularities of
manifestation, when they are present (hebephrenic and catatonic
symptoms). In connection with these indices, there seems to exist,
from the very onset of the disease, a certain mental stamp that
points towards termination in dementia. In the beginning of the
disease, the diagnosis is rather less difficult in the first variety of
the disease, described under the heading "a." There is not much
difficulty in diagnosing the typical cases of hebephrenia and the
catatonic and paranoidal forms, which, from the very onset, are
characterized by psychic enfeeblement. In other cases, it seems
necessary to differentiate the disease from amentia, periodic psy-
choses and delirious attacks of the degenerate. In such cases, the
differentiation is at times very difficult, and the diagnosis can be
made only after a long period of observation. As regards the
terminal state of the disease, the only differentiation to be made is
from secondary dementia; in this form of disease there may also
be manifested, certain gestures, stereotypias and poses, which are
considered by some as being characteristic of dementia praecox.
The age at which the disease sets in becomes a valuable point, and
besides, the onset and the whole course of the disease during the
acute stage must be taken into consideration.
There is no ground for denominating a disease dementia prsecox
if it sets in after the adolescent period, — when the psychic side of
the subject has become matured; an acute onset with a subse-
quent demential ending should not influence the making of the
diagnosis in favor of dementia prsecox. Such dementia is not
primary, but secondary. It is a question whether the third group
of dementia praecox indicated above should be classed with this
latter. To avoid a battle of words, however, it must be remarked
that the definition of dementia praecox corresponds well with the
form described; the dementia is incurable from an early age; the
secondary dementia is complerely covered by the early dementia,
which was not cured before the completion of the psychic forma-
tion of the subject. I agree that other psychoses than dementia
praecox may develop and during the adolescent period end in de-
mentia ; it is possible that in the future we shall be able to differ-
entiate between such forms and dementia praecox ; but at present
we cannot differentiate between secondary dementia of adolescence
and dementia praecox.
We do not know of any special pathology characteristic of de-
mentia praecox. We can only surmise that some special anatomi-
cal changes underly all forms of dementia.
Tg2 DEMENTIA PR^) COX.— Prof. Serbski.
The theory of auto-intoxication as a cause of the disease is quite
alluring, but it cannot be substantiated. The theory of infection
with the products of the sexual organs is altogether unfounded.
Kraepelin's views ( 1 1 ) are refutable. According to him, there
exists an intimate correlation between dementia prsecox and the
period of sexual development, menstrual disturbances and child-
birth. This view is untenable because there are cases in which
these conditions are absent ; there are cases where we cannot even
point out any one cause, external or internal ; besides, the above
mentioned conditions are not specifically responsible for the occur-
rence of dementia prsecox ; other mental manifestations may set in
through similar causes.
The treatment of this disease must remain ineffectual so long as
we remain ignorant of its cause. In the future, perhaps serum-
therapy and organo-therapy will play an important role; for the
present, however, a good deal should be accomplished by rational
treatment at our disposal, preventing the progress of the disease.
General regime, employment, mechanical and other, should be
given. In private institutions, where regular employment is not in
vogue, the patient's welfare is rather at a disadvantage. The open
air and country life are most advisable. As regards bed treatment,
Neisser and Korsakoff have pointed out the danger of too pro-
longed administration of the treatment; it should be limited to the
acute stage only and promptly discontinued with the disappearance
of the latter.
(Report read at the Second Congress of Russian Psychiatrists,
January, 1902. Abstract for publication in the Journal of Mental
Pathology made by the author. Full report published in Journal
s. s. Korsakova, No. 1-2, 1902).
REFERENCES.
1. MOREL. Traite des Maladies Mentales, i860.
2. KRAEPELIN. Psychiatrie, 6 Aufl., II bd. Weygandt. Berl Kl.
Woch., No. 3-4, 1901.
3. KRAEPELIN, 1. c, bd. II, p. 137-148.
4. KRAEPELIN. Einfuerungen in die Psych. Klin., p. 25, 29, 1901.
5. PROF. MERJEEVSKI, t. V, Vip. 2, p. 193. Vestnik Klin. Psych.
Daraszkievicz. Ueber Hebephrenic. Dorpat, 1902.
6. V. P. SERBSKI. Formi Psychitcheskavo Rastroistva, opisivaiemaia
pod imenem Katatonii, Moskva, 1890, and Erlenmeyer's Centralbl., p. 145,
1891.
7. SEGLAS. La demence paranoide. Ann. Med.-Psych., Septembre-
Octobre, 1900.
8. SERBSKI, 1. c.
9. SERBSKI, 1. c, p. 159.
10. FRENSBERG. Ueber motorische Symptome bei einfachen Psycho-
sen. Arch. f. Psych., XIX. Also Serbski, I. c, p. 43.
11. KRAEPLIN. Psychiatrie, IIB, p. 204.
THE PSYCHOSES WITH DELUSIONAL INTER-
PRETATION AS A BASIS.
BY DRS. PAUL SERIEUX AND J. CAPGRAS.
The delusional interpretations which sometimes appear as true
hallucinations, present themselves under three distinct clinical
aspects.
i. — Episodic interpretations may be observed during the course
of the majority of mental diseases ; the role of these interpretations
is of no importance.
2. — The delusional interpretations may, by their more or less ex-
clusive predominence over the sensory disturbances, constitute a
syndrome common to a certain number of clinical forms of mental
disturbance, either acute (generally without systematization) or
chronic (with systematization). The syndrome of an acute
psychosis, with delusional interpretations as a basis, is found in in-
sanity of the degenerate, in presenile melancholia, periodic insan-
ity, toxic delirii and dementia prsecox. That syndrome is dependent
on a disturbance of judgment, which, aside from the influence of
an insane predisposition, is in itself a functional manifestation of a
condition of mental confusion, due either to an obsessional emo-
tion, or a psychic enfeeblement, — congenital or acquired.
Delusional interpretations may also play a predominant role in
certain chronic psychoses, as in the following : the period of incu-
bation of the delirii of persecution, senile delirium of persecution
and insanity of the persecutes-persecuteurs. The appearance of
this syndrome is due either to intellectual enfeeblement or to obses-
sional ideas.
In a word, in this category, the delusional interpretations, play-
ing a more prominent role than the sensory disturbances, are pre-
eminent in the symptomatic tableau of distinct psychoses.
3. — In the third category, the delusional interpretations consti-
tute the preponderating symptom of a chronic systematized de-
lirium, which presents well defined characteristics in its symp-
tomatology and evolution and may be considered as a clinical au-
tonomy. This psychosis is characterized by the following signs :
very slow development of the systemtized delirium of various
coloring (most frequently there is a combined delirium of perse-
184 DRS- SER1EUX AND CAPGRAS.
cution and grandeur) ; almost constant absence of hallucinations
(or very slightly marked presence of same) ; a marked variety of
delusional interpretations, which constitute the very basis of the
morbid conceptions; a very slow and progressive course; absence
of systematic evolution and absolute incurableness ; persistence of
integrity of the intellectual faculties (no periods of dementia).
This clinical form of mental disturbance we propose to designate
chronic systematized psychosis with a basis of delusional interpre-
tations, or more concisely, — psychosis with a basis of interpreta-
tion. The disease has been studied by many authors, notably
Lasegue, in 1852, Legrain (1886), and particularly Seglas
(1890), Serieux (1890)* and Magnan, in France; in Germany, —
Sander, Kraepelin (1889) and particularly in 1899.
THE ONSET. — Ther is no form of mental disease which pre-
sents as much difficulty in fixing the date of onset as does this one ;
the extreme slowness of incubation, the age of the delirium when
the physician is called into consultation, the reticence of the patient
and his congenital tendencies to delusional interpretations, all con-
tribute to make the difficulty. Besides, these patients have a par-
ticular aptitude for bringing their remotest past into correlation
with their unhealthy conceptions (retrospective delirium). It
may be said, with a certain reserve, that the psychosis with a basis
of interpretation sets in, generally, between the ages of 20 arid
40, especial predilection being noticed during the periods between
20-25 and 35-40. For this reason, two forms are pointed out:
one with a precocious and the other with a tardy onset. In some
cases, it seems that onset may be said to date from very childhood ;
here, however, a great difficulty presents itself when one tries to
differentiate between a true precocious delirium and one that is
built up by the patient through retrospection.
From a symptomatic point of view, it is important to bring to
light the basis of well systematized conceptions, which is often
built on false deep-rooted convictions of the patient; the coloring
of the delirium is not less important ; it is generally a combination
of ideas of persecution and grandeur, and is very difficult to
differentiate from the chronic delirium of Magnan. An examin-
ation of the delirium under consideration shows that the psychosis
is based exclusively on a vast structure of multiple delusional
interpretations, which, without the intervention of hallucinations,
suffices for a well rounded construction of an unfounded history.
In some cases hallucinations may manifest themselves; but their
*P. Serieux. Le delire Chronique a evolution systematique. Bull, de la
Soc. de Med. de Belgique, 1890-1901.
DRS. SER1EUX AND CAPGRAS. 185
role is only secondary; their presence only renders the making of
the diagnosis more difficult, until a thorough examination shows
that the fundamental basis of the disease consists of delusional
interpretations.
THE ASPECT of these patients is of interest, as they appear
less "delusional" than do those suffering from ordinary delusions
of persecution. Their lucidity and syllogistic faculties are less
impaired; the absence of disturbances of the general sensibility
and particularly the absence of the psycho-motor hallucinations, en-
ables them to dissimulate their true condition. The well devel-
oped memory and ready dialectic capacity also enables the patient
to defend his erroneous convictions in a manner nearer the normal
than that seen in the ordinary subject with delusions of persecu-
tion : the latter generally complains of physical persecutions, using
neologisms, and his sensory disturbances brand him more and
more as a pathological subject as time goes on. The one subject to
the psychosis with a basis of interpretation accumulates proof
upon proof, having a ready answer to every question, citing dates,
posing dilemmas and bending every insignificant fact to suit his
case. A conviction, thus fortified, from day to day, by accumu-
lative proofs, remains unshattered and may even lead to psychic
contagion (folie a deux).
At times, these subjects, like the persecutes-persecuteurs, react
against those to whom they ascribe their grievances, thus be-
coming persecutors.
THE FREQUENCY of this psychosis with a basis of interpre-
tation is rather rare: one case in 90 or 100 admissions. The sex
does not seem to have any marked influence.
THE DURATION of the disease is indefinite. It is impossible
to distinguish either a systematic evolution or well defined periods.
THE TERMINATION generally takes place from senility;
dementia, so frequent an end in paranoia and systematized delirii,
is rather a rare occurrence in the psychosis with a basis of inter-
pretation.
THE PROGNOSIS of this chronic affection is unfavorable. A
cure never takes place.
THE ETIOLOGY is difficult to outline, outside of the unques-
tionable influence of degeneracy. The influence of auto-intoxica-
tion, considered as a cause of dementia prsecox, cannot be consid-
ered as a cause in this affection.
DIAGNOSIS. — Patients suffering from the psychosis with a
basis of interpretation are too frequently confounded with those
afflicted with hallucinatory persecution or else with the persecutes-
persecuteurs. They are particularly confounded with the latter
!g6 DRS. SERIELIX AND CAPGRAS.
when they react similarly ; besides, there seems to be some similar-
ity between them by reason of the absence, in both cases, of hallu-
cinations, by the intellectual activity and the lucidity. There, are
some characteristic traits, however, which distinguish these two
psychoses. The delirium of the cases here considered is based on an
obsessional idea, which irrevocably burrows its way into the mind,
without the necessary participation of true delusional interpreta-
tions. In the persecutes-persecnteurs, on the contrary, the delirium
becomes systematized by reason of multiple delusional interpreta-
tions. In the latter cases, there is generally an authentic fact that
is amplified through the natural tendency of the subject; obses-
sional ideas are thus created, which subjugate the patient's acts to
themselves, so that these subjects are not as much sufferers from
delusions as they are invalid through obsessions. They act very
much more than they react from delirious conceptions. The sub-
jects suffering from the psychosis with a basis of interpretation, on
the contrary, suffer a great deal more than they act. If, however,
they do sometimes react vigorously, it must be borne in mind that
their marked reticence suppresses reaction, which, once brought
into play, may overstep the ordinary limits of action in these cases.
Besides these distinctions, one must study the course and evolution
of the disease, when there is any difficulty in differentiating this
form from the chronic delirium of Magnan.
Clinical differentiation must also be made between this disease
and the following: paranoidal dementia, acute hallucinatory psy-
chosis, acute psychoses with a basis of symptomatic interpretation
of periodic insanity of the degenerate, melancholia and finally,
certain delirii of senility.
(Paper read before the Paris Medico-Psychological Society. Abstract
for publication in the Journal of Mental Pathology made by the authors.
The paper is published in extenso in the Proceedings of the Society, April,
1902).
THE GENESIS OF EPILEPSY CLINICALLY CON-
SIDERED. THE PATHOLOGY, PROPHYLAXIS
AND TREATMENT OF EPILEPSY.
ILLUSTRATED BY CASES AND STATISTICAL TABLES.
BY LOUISE G. ROBINOVITCH, B. ES L. (PARIS), M. D.
Foreign Associate Member Medico-psychological Society, Paris; Member New York
Academy of Medicine.
( Continued. )
THE FATE OF THE ALCOHOLIC FAMILY.
The family of the alcoholic is small, as a rule, and the offspring
may be afflicted with any form of psychoses or neuroses. — Epilepsy,
idiocy, imbecility, insanity, hysteria and criminality are most fre-
quent manifestations. — Where the number of children is large, the
first bom only are apt to survive, the last dying in infancy of men-
ingitis.— Cases.
With the preceding description of the clinical manifestations of
alcoholism and its cerebral anatomo-pathology, one is well prepared
to trace the cause and effect, — the relation existing between pa-
rental alcoholism and epilepsy in the offspring. I have already
had occasion to state in this paper that alcoholism in the parent may
become the cause not only of epilepsy in the offspring, but also of
many other morbid psychic manifestations. I have demonstrated,
in previously published papers, the role parental alcoholism plays in
the genesis of criminality, idiocy and imbecility in the offspring.
Epilepsy is one more morbid variety, which owes its birth to the
same cause. I have had occasion to mention the paucity of the
number of children in the alcoholic family, and have quoted Mo-
rel's statement to that effect, which consists essentially of the truth
that were one to suppose a whole community addicted to the abuse
of alcohol, such a community could become extinct.
Such, then, are the effects of alcohol on the human family.
The alcoholic family is remarkable not only for the small num-
ber of children born, with the various psychopathic attributes of
such children, but also because of the fact that where a large num-
ber of children are brought into the world in such a family, the ma-
jority of them die in infancy of convulsive disturbances, the sur-
vivors bearing; the indelible mark of a defective nervous system,
l88 GENESIS OF ELIPEPSY.— Dr. Robinovitch.
Here, indeed, are two families whose records, copied from the
statistical table that is appended to this paper, are in accord
with the above statement.
Case VII. — B. G., 24 years of age, entered the Admission Bu-
reau, Ste-Anne Asylum, June 22, 1899, suffering from mental de-
bility and epilepsy. The father was a drunkard; the record of
his 13 children is :
One girl died at the Ste-Anne Asylum, insane and epileptic.
One girl has been epileptic since the age of 13.
One girl is healthy, but wet her bed up to the age of 12 years.
The fourth child is our patient, and nine children died in infancy
of "convulsions."
Case VIII. — The patient indulges in cognac and in one litre of
wine daily. He married when 18 years of age, and has had nine
children. Their record is :
1, a boy, born in 1882, is extravagant and has perversion of the
senses.
2, a boy, born in 1883, is an idiot, an inmate at the Bicetre asy-
lum.
3, a girl, born in 1886, is afflicted with mental debility.
4, a boy, born in 1888, died, at the age of three years, of diph-
theria.
5, a girl, born in 1890, is healthy.
6, a boy, born in 1892, suffers from mental debility and epilepsy.
7, a girl, born in 1895, died at the age of 8 months, of "con-
vulsions."
8, a girl, born in 1896, died when six months old, of "con-
vulsions," and
9, a girl, born in 1897, died when 7 months old, of "convul-
sions."
It is instructive to remark that in both the cases cited, the first
born children, although afflicted with various psychoses and neu-
roses, are yet sufficiently valid to survive and grow to mature age ;
the latter born, however, when the alcoholic parents are under-
mined in health, are too invalid to survive the age of infancy, dying
of "convulsions."
It is true that in other cases cited, the first born died of "convul-
sions," but when this is the case one is justified in presuming that
the alcoholic indulgences were of a marked degree at the time of
the conception of those children ; as a rule, when the first children
of alcoholic parents die of "convulsions" there are few chances of
any healthy children being born subsequently, unless the parent
stops drinking entirely. On the other hand, as seen in case VIII,
GENESIS OF ELIPEPSY.— Dr. Robinovitch. j^
where one healthy child is born while all the others are not healthy,
two points of interest are to be considered :
1, will that healthy child be healthy when it grows up?
2, if it is healthy throughout life, which is hardly plausible, then
— did healthy heredity on one side exert a sufficiently strong influ-
ence and transmit to the child sufficient resisting power to enable it
to exist ?
Those who have devoted themselves to the study of the relation
of alcoholism to epilepsy agree that alcohol is a potent factor in the
production of convulsive diseases. One of Dr. Magnan's dis-
tinguished pupils, Dr. Legrain, says in this respect :
"If, indeed, alcohol, by its action, does induce directly the con-
vulsive state in the individual, it is a well-known fact that it (the
alcohol) induces it (indirectly) in his descendants. It is not neces-
sary any more to demonstrate that the sons of drunkards are, in a
large majority of cases, candidates for some or other convulsive
neurosis. Now, as we have shown, with documentary proof, that
a large proportion of drunkards give birth to drunkards also (two-
thirds), it follows that in those latter, in a large number of cases,
alcoholism and the convulsive state will coincide, both having as a
primary cause the influence of heredity. These facts are so true
that one could almost lay down a general formula : father drunk'
ard, son epileptic, as we have already established the formula:
father drunkard, son drunkard; and these two formulae are fre-
quently confirmed by clinical data.
"The infantile convulsions represent the most elementary for-
mula in the descendants of alcoholics. The convulsions take
place during the very first few months or years after birth, when
the children are under the preponderating influence of heredity.
The convulsions are so much related to this influence that one sees,
more frequently, almost all the children of one parentage afflicted
with convulsions. These children are, in many cases, also future
epileptics.
"Next to infantile convulsions come, in frequency, the epileptic
neuroses." (Legrain, L'heredite et Valcoolisme, p. 342.)
IV.
GENERAL CONSIDERATION OF THE VARIOUS
CAUSES OF EPILEPSY, AND STATISTICAL
TABLES SHOWING THE CAUSES OF
EPILEPSY.
Alcoholism in the parent is a leading cause of epilepsy in the off-
spring.— Epilepsy may also be inherited directly from the parent.
The insanities, hysteria, general paralysis, imbecility and neuroses
jgo GENESIS OF ELIPEPSY.— Dr. Robinovitch.
of the parents are factors in the production of epilepsy in the off-
spring.— Organic diseases, such as tuberculosis, etc., may be ex-
citing causes of epilepsy in the offspring. — Syphilis, small-pox and
other contagious and infectious diseases may be exciting causes. —
Maternal impressions are sometimes exciting causes. — Statistics
showing the causes of epileptiform and epileptic attacks. —
The clinical data that have been cited up to now show that al-
cohol is the leading cause of epileptiform and epileptic attacks.
Yet one can hardly appreciate the extent to which alcohol is at the
root of those diseases, and particularly of epilepsy. The analysis
of the clinical material submitted below gives one an idea of the
degree to which alcohol is a specific factor in causing epilepsy.
Where epilepsy is inherited from an epileptic parent, one may in-
criminate alcohol as a cause only indirectly, as the histories in such
cases generally show that the grandparents suffered from alco-
holism.
The insane and imbeciles, the criminal and neurotic are another
set of parents who are apt to give birth to epileptic children in a
proportion that will be shown below.
In papers referred to here I brought to light the extent to which
idiocy, imbecility and criminality are due to parental alcoholism;
it is important, then, to trace the cause of epilepsy, — when it
springs from imbecile and criminal parentage, — to its original
source, if one is to be sincere in such an investigation.
The neuroses and organice diseases appear as causes of epilepsy,
as do maternal impressions during pregnancy; but the clinician
must scrutinize the facts thoroughly in such cases before incrimi-
nating any one of those maladies as a radical cause of epilepsy. One
must search diligently for an accompanying predisposition for in-
heriting epilepsy. For, to paraphrase Dr. Magnan's claim in this
respect, if tuberculosis causes epilepsy, then why is there not an
epileptic offspring in every tubercular family ?
Syphilis, small-pox and infectious and contagious diseases dur-
ing pregnancy are apt to cause epilepsy in the offspring. And yet
it seems logical to apply the above reasoning in this instance as
well.
As every one knows, syphilis is a prevalent disease, yet not every
syphilitic parent gives birth to an epileptic child.
The important questions of the causation of epilepsy can be re-
solved only by means of a thorough study of the family history as
well as of the members of the family, when possible.
To conclude, the tables show that alcoholism in the parent is the
cause of epilepsy in the offspring in an overwhelming majority of
cases.
GENESIS OF ELIPEPSY.— Dr. Robinovitch. igi
A statistical table of records of patients
admitted to the Admission Bureau, Ste-Anne Asylum, Paris, dur-
ing the years 1897, J^P^ an^ I^99-
The patients included in this table are those who suffered from
epileptiform or epileptic attacks. Only those patients were chosen
whose friends could furnish sufficiently intelligent information.
The records of patients about whom no information could be ob-
tained were left out. This table is an abstract of the one obtained
from the records. In preparing the table it became evident that
the patients should be grouped in two classes :
Class I. — Chronic alcoholics having no heredity to account for
their convulsive attacks.
Class II. — Those with convulsive attacks whose heredity is
traceable.
As the statistical data were collected at two different periods,
with one year's interval, they are divided into two groups and will
be cited separately because there is a distinct discrepancy between
the numerical values which they show. The discrepancy will be
properly explained, however, after the table is cited. .
Table J, a. — Chronic alcoholics admitted to the Admission Bu-
reau, Ste-Anne Asylum, Dr. Magnan's service, from April, 189/,
to June, 1898:
Clinical record of twenty-five alcoholic patients.
2 patients have vertigo and slight convulsions. One of
these patients had but one child, who died when 22 days
old.
15 patients have epileptiform attacks. The only child re-
corded among these had convulsions when a nursling.
1 has physical stigmata of degeneracy ;
3 are addicted to the abuse of absinthe ;
8 patients have 3 give no other information that that
epilepsy. they are chronic alcoholics ;
1 has three children, of whom one is
an epileptic.
Total 25.
Table I, b. — Chronic alcoholics admitted to the Admission Bu-
reau, Ste-Anne Asylum, Dr. Magnan's service, from July, 1898, to
June, 1899.
Clinical record of twenty-four patients.
18 patients have epileptiform attacks. One of these has
had nine children, whose record is given in this paper.
Another patient has physical stigmata of degeneracy.
IQ2 GENESIS OF ELIPEPSY.— Dr. Robinovitch.
6 patients are epileptics; one of these has physical stig-
mata of degeneracy
Total 24.
Barring the three epileptic cases, in table "I, a/' addicted to the
abuse of absinthe, it is logical to surmise that in the remaining
cases of frank epilepsy there exists, besides the chronic alcoholism,
some underlying cause, which, in conjunction with the chronic
alcoholism, causes true epilepsy to take place. As has already
been shown, absinthe is apt to induce true epileptic attacks, while
chronic alcoholism induces epileptiform attacks. Doubtless, a
thorough search into the history of the antecedents of those epi-
leptic cases said to have no morbid heredity would reveal some
cause which, in conjunction with the chronic alcoholism, is re-
sponsible for the epilepsy.
Table II, a. — Seventy-six cases with convulsive attacks, whose
heredity is traceable, admitted to Ste-Anne, from April, 1897, i0
June, 1898:
Clinical record of seventy-six patients.
62 patients epileptic
10 hystero-epilepsy
4 epileptiform attacks
Total 76.
Heredity in the seventy -six cases.
54 cases father alcoholic
22 cases other heredities
Total 76.
The other heredities are:
2 have epileptic fathers.
1 has an epileptic mother,
had epileptic 2 have epileptic mothers, one of whom
parents. is also insane.
1 mother suffers from "petit mal" and
incessant muscular movements.
2 have epilep- 1 epileptic.
tic uncles. 1 epileptic and alcoholic.
1 has vertigo. 1 mother has spells of vertigo.
2 suffer _ from 2 mothers have hysterical spells,
hysteria.
GENESIS OF EL1PEPSY.— Dr. Robinovitch. Tg^
i father imbecile, is an inmate in the
Bicetre Asylum; mother suffered
2 have insane from mental debility and died in a
parents. hysterical spell. Patient alcoholic.
i father died insane in the Ville-Ev-
rard asylum.
2 collateral ~" . 0 .
, r i maternal aunt insane at bte-Anne.
f -1 . i maternal uncle insane.
family insane
i father died of cardiac disease; pa-
2 have physical tient has physical stigmata of degen-
stigmata of eracy.
degeneracy. i patient has physical stigmata of de-
generacy.
i father highly nervous and violent of
nature.
I mother nervous, paternal grand-
father nervous.
i mother nervous, grandfather alco-
holic.
I nine children in family, seven of
... whom died of convulsions.
,. I twin sister, ioj^ years of age, had
convulsions when 6 weeks old.
Total 22.
Table II) b. — Sixty-four cases with convulsive attacks, whose
heredity is traceable, admitted to the Ste-Anne Asylum, Dr. Mag-
nan's service, Paris, from June, 1898, to June, 1899:
Clinical record of sixty-four cases.
53 • epileptic
10 hystero-epilepsy
1 epileptiform
Total 64.
Heredity in the sixty-four cases.
36 fathers alcoholic
28 other heredities
Total 64.
194
GENESIS OF ELIPEPSY.— Dr. Robinovitch.
have epileptic
heredity.
The other heredities are:
I father had convulsions and cardiac
disease.
aunt epileptic, brother insane,
paternal uncle epileptic,
father and brother epileptic,
father somnambulist, brother rach-
itic.
8 have insane
heredity.
3 have anatomo-
nervous
heredity.
4 tubercular
history.
I syphilitic
heredity.
I invalidity.
I father insane, killed himself; pater-
nal grand uncle killed himself;
mother nervous, exalted.
i mental debility of mother.
i mother died insane.
i paternal grandfather insane.
i father died of general paralysis.
i aunt died insane, patient alcoholic.
i mother insane, father died tubercu-
lar, two brothers epileptic, patient
alcoholic.
i mother hysterical when young.
paternal grandmother paralyzed ;
maternal grandfather died of par-
alysis; one sister had convulsions
when young.
mother had disease of spinal cord,
father nervous,
father died of cerebral apoplexy.
mother tubercular, had a fright
while pregnant with patient,
mother tubercular, father had
Bright's disease and grandfather
had disease of spinal cord,
mothers tubercular.
i father syphilitic and has cardiac dis-
ease, mother feeble physically.
I epilepsy set in on patient's recovery
from typhoid fever, when ten years
of age.
I grandfather alcoholic, father violent,
mother has cardiac hypertrophy;
one child, 9^2 years old, had menin-
gitis and convulsions.
GENESIS OF ELIPEPSY.— Dr. Robinovitch. ig$
I father violent, mother died at 26
years of age.
1 maternal im- . . . , .
, 1 maternal impression during preg-
pression dur- - . . . , . ....
f nancy: fright at seeing a child
lngf pregr- <=> <^
& r & killed while pregnant with patient.
nancy.
1 no positive pathological heredity.
2 absence of morbid heredity.
Total 28.
The discrepancy between the percentages of alcoholic parents
in table II a, and table II b is well accounted for. As is well
known, the service in the Admission Bureau, at the Ste-Anne
Asylum, is the best conducted of any asylum. During the three
summer months, when many of the asylum physicians are absent
on vacation, a large amount of work falls on one physician, many
services depending on his available time. The information gath-
ered from friends necessarily becomes somewhat curtailed in some
cases. It is safe, therefore, to presume that, if anything, the per-
centage of alcoholic parents in table II b is rather underestimated,
for the reason given, than that the one in table II a is overesti-
mated.
The statistics above shown are convincing to the effect that
alcoholism is the original source of the convulsive diseases in a
marked. percentage of cases. True epilepsy was traced thus: in
table II a, 54 out of 76 patients had alcoholic parents, and in table
II b, 36 out of 64 patients had alcoholic parents.
As for the epileptiform attacks, alcohol was responsible for
their occurrence in forty-nine of the cases admitted during the
period of three years and examined as stated.
Broadly speaking, then, convulsive diseases are due to alcoholic
abuses, either by the patient himself or by his antecedents, in 140
out of 189 cases.
From what has been brought out in this paper it is evident that
a great duty devolves on the clinician ; he must have a thorough
understanding of the working of alcoholism on the human brain ;
he must use his influence in the struggle against popular alcohol-
ism.
(To be continued.)
The Journal of Mental Pathology.
Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. II. MAY, 1902. No. 4 *
STATE PUBLISHING COMPANY, Publishers,
290 Broadway, NEW YORK.
MSS. and Communications should be addressed to the Editor, at
28 West 126th Street, New York.
Address bulky mail matter to P. O. Box 102s, New York.
This Journal is published monthly, except in August and September.
Price of subscription, $2.50 per annum. Single copies, 50 cents.
Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope. News items from Institutions will be given all space
available.
The State of Rhode Island is the smallest State in the Ameri-
can Union in point of geographical size ; oddly enough it boasts of
two State Capitals, and in one of these, the City of Providence, is
published the Providence Medical Journal. We are in receipt
of No. 3 of Vol. 3 of this Journal, a handsome appearing bi-
monthly publication consisting of thirty-three pages of reading
matter. From the contenis of the third page of the issue above
mentioned, we learn that this publication most emphatically dis-
approves of a grievous error in journalism into which almost all
the leading American medical publications have fallen. To be
precise: — we are told, editorially, that the practice of publishing
"abstracts" is "because of its general adoption, in some ways a
bore.". The editor of this publication further intimates that he
has cause for self-gratulation in the fact that the Providence
Medical Journal "has not since its beginning published a line which
has appeared elsewhere in print, save in perfunctory notices."
We congratulate the editor of the above named estimable publi-
cation on the peculiar merit of his journal in general and on his
frank and easy appreciation of its qualities in particular. We
cannot, however, allow the incident to pass without making some
EDITORIAL. 197
plea for all the other editors of this broad land, who are un-
able to appeal for a like measure of professional appreciation and
approval. Frankly speaking, — we believe in the "abstract" as a
concrete proposition. While we do not presume to pit the value of
our opinion against that of the editor of the Providence Medical
Journal, yet it seems to us that the abstracts of the scientific papers
contributed by the members of the medical profession and by scien-
tists all the world over, as the same appear in the various periodi-
cals of the civilized world, have some value. We would not for
a moment intimate that original work is not preferable to abstracts,
and if it were possible for every publication to contain, in every
issue, original articles covering all the subjects covered by all the
other publications in the world, a condition would prevail which
would entirely do away with the necessity for abstracts ; but as it
seems impracticable to publish a weekly or monthly journal con-
taining original papers only, as above denned, we feel that we shall
still have to fall back on the ever-useful "abstract."
There is a charm in the abstract. By its aid we are enabled to
put before our readers a series of pictures, so to speak, illustrating
the state of scientific thought and investigation throughout the
world, bringing our own countrymen into most intimate contact
with the scientists, students and philosophers of the entire domain
of science. The moral effect of such association cannot be over-
estimated ; it often enables us to broaden our point of view and to
gradually do away with that certain human trait which, in the
language of the day, is denominated "pusillanimity," this trait
often being accompanied by a variety of psychic blindness which
makes us see ourselves as being all that is fine and desirable and
which makes us see our neighbors as being all that is bad and un-
desirable.
We have sympathy for the editors who have incurred the dis-
approval of the Providence Medical Journal. It is true that in
order to be able to control the efforts of the "abstracters of current
literature," it is necessary for an editor to keep in touch with the
progress in thought of the entire world of scientific "workers" and
to be acquainted with at least four or five foreign languages, as
he would otherwise be at the mercy of any unscrupulous maker of
abstracts who might choose to impose on his ignorance. It is
therefore obvious that an editor who happens to be free from the
burden of "accomplishments" can easily fortify himself against
imposition and deception by emulating the example of our es-
teemed contemporary and never publishing a "line which has ap-
peared elsewhere in print."
There is a certain charm in exclusiveness, and we have no doubt
198
ON ALEXIA.
that there is a certain merit in being different from all the rest of
the world; the unusual always attracts, as witness, the "fat boy"
who figures so prominently in the Pickwick Papers, and who aston-
ishes all beholders by his peculiar aptitude for inopportune and
wholly irrelevant slumber. So far as we remember, the fat boy
of the Pickwick Papers was perfectly satisfied with himself; the
only thing that annoyed him was the insufficient size of the pork
pie and the wholly illogical and unnecessary activity of those be-
nighted mortals with whom an unkind fate forced him into daily
contact.
Long life to the "abstract" say we. We hope to see the day
when every American medical publication will serve as a ready in-
dex to all the other medical publications of the world, so that the
busy practitioner and student may be enabled to readily refer to
every scientific publication of value in this wide world, without
having to be the possessor of a private library, or of an income suf-
ficiently liberal to enable him to subscribe to all the medical publi-
cations extant.
ON ALEXIA.— PROF. MENDEL presented a case of alexia in
a man 48 years of age, whose hereditary history was good, and who
was free from syphillis ; but he was addicted to the alcoholic habit.
In June, 1901, his eye-sight suddenly became impaired, first in the
right and then in the left eye, so that he experienced difficulty in
reading; this was soon followed by disturbances of speech, which
were expressed by an inability to use the right words. He could
write, but found it impossible to read. An ophthalmoscopic exam-
ination showed that his eye-sight and the retina were normal, yet
he had right hemianopsia. Red was recognized correctly, but blue
and green were often taken by the patient for yellow. Outside of
these indications, there were no nervous disturbances. A physical
examination showed that the cardiac area was somewhat extended
towards the right and that the arteries showed signs of sclerosis.
The details of the alexia were as follows : the patient could recog-
nize as well as indicate letters, but he was unable to read words,
not even his own name; yet he could write, under dictation or
spontaneously. He could read hand writing if he observed the let-
ters while they were being written. In explanation of these com-
plex symptoms Mendel gave the following diagram: there is a
communication between the centres, where are deposited the
sounds and images of letters respectively ; these centres are in their
turn in communication with the verbo-motor centre ; there is also a
communication between the visual and graphic centres of letters,
TOULOUSE-RICHET METHOD IN EPILEPSY. 199
enabling us to reproduce our impressions of letters in graphic lines.
The word-centre is in intimate as well as intricate connection with
the centre of letters and its corresponding auditory centre. The
building of a word with letters, therefore, implicates several cen-
tres which must all be in perfect order. Thus, in this patient, who
can read letters, but cannot build words with the same, as is usual,
there must be an interrupted connection between the letter and
word centres, he suffering, therefore, from a subcortical verbal
alexia. The author has found forty similar cases in literature ; but
there are only three or four of those that were uncomplicated.
Subcortical alexia is generally accompanied by right hemianopsia ;
although there is one case recorded with left hemianopsia ; this case
was left-handed. In most cases the autopsy revealed a focus in the
inferior part of the gyrus angularis.
The letter-centre is located in the occipital lobe, the centre of
hearing in the superior temporal and the centre for building words
in the left gyrus angularis. An interruption of communication
between the left occipital lobe and the gyrus angularis destroys the
ability to build words. As the occipital lobe is also the centre of
sight, its lesion must of necessity cause right hemianopsia (psychic
blindness) . In the case under consideration, there must have been
an apoplexy from the inferior occipital artery, causing a throm-
bosis. Such an occurrence is not unusual in alcoholic cases with
arterial sclerosis. (Algem. Wiener Medizin., Zeitung, Feb. 18,
1902.)
ON THE TREATMENT OF EPILEPSY BY THE TOU-
LOUSE-RICHET flETHOD DRS. JENO and AND. BAG-
ARUS : Of the many treatments in vogue at various periods in the
history of medicine, none has been curative, but some have been
palliative. Although eager to find methods better than those of
our predecessors, we seldom succeed, and often fall into the trap of
advocating methods that are even dangerous. One of the recent
methods (1893), — the Flechsig cure, belongs to the latter group;
the treatment consisted of combining opium with the bromide salts.
In 1897 the originator of this "cure" himself admitted that he had
little faith in the efficacy of the treatment and that one of his en-
thusiastic pupils had made the reputation of the method. Many
other enthusiasts were soon forced to forsake their newly formed
beliefs in the virtues of the method, as fatalities resulted from that
treatment. The latest method in vogue is called the Toulouse-
Richet cure. It consists of an artificial abstraction of the table
salt from the system (by withholding the salt from the foods in-
200 LIGHT REFLEXES.
gested) and the administration of certain doses of the bromide
salts; the bromides are virtually substituted for the chloride salt,
and the former act on the system more energetically, and more
thoroughly.
The authors experimented on 15 cases of epilepsy, administering
the Toulouse-Richet treatment. The patients were daily given 2
litres of milk, 2 eggs, 750 grams of bread for the men, and 500
grams for the women; besides, every patient was given 3 grams
of bromide during a period of two weeks, after which the dose
was reduced one-half. The treatment was begun in May, 1901.
The conclusions drawn by these authors are to the effect that while
the number of fits was reduced in some cases, there was a decided
increase of the attacks in others ; some cases suffered from spells of
collapse, which must be ascribed to the abstraction of the chloride
salt from the system and to the consequent poisonous action of the
bromides. Two cases ended fatally, and the cause of death was
invariably given as having been bromide poisoning.
The authors conclude that the Toulouse-Richet cure for epilepsy
neither cures no ameliorates the disease. While the artificial ab-
straction of the chloride salt from the system heightens the action
of the bromides, the advantage carries with it a drawback, — a great
possibility of bromide poisoning. The method must, therefore, be
considered as being dangerous.
In order to discover whether the artificial abstraction of the salt
or the excessive action of the bromides was responsible for the sink-
ing spells in the patients, the authors chose two patients who were
not epileptics and put them on the diet above referred to, with-
holding the bromides. The patients showed signs of collapse after
two days' treatment, and the authors conclude that the artificial
abstraction of the chloride salt from the food ingested is in itself
a potent factor in the production of collapse. (Pester Medi-
2tnisch-Chirurgische Presse, March 23, 1902).
ON THE LIGHT REFLEX — DR. MARADON DE MONT-
YEL says that the disparity in figures obtained by previous in-
vestigators regarding the pupillary reflexes, is due to the fact that
those figures were indicative of conditions of various patients, dur-
ing various stages of the disease ; it is more rational to compile the
figures furnished by the examination of the same patients during
similar stages of the disease. His results obtained from 750 ob-
servations, under the conditions indicated, are as follows :
1. The light reflexes in general paralysis are more frequently
abnormal than normal.
LIGHT REFLEXES 2OI
2. Exaggeration of those reflexes was exceptional; decrease
was at least 20 times more frequent.
3. Decrease and abolition were observed in about equal propor-
tions, with 4 per cent, in favor of the latter.
4. Whether there was exaggeration or decrease of the reflexes,
moderation was observed in all the former, and three times in the
latter.
5. The alterations in both pupils were always identical and to
the same degree; in exceptional cases only was there one normal'
and one abolished reaction.
6. During the first period normal reaction was 10 per cent,
more frequent than abnormal, whereas during the second and
third stages, abnormal reaction was more frequent. Besides, the
maximum abnormality was found during the intermediary stage,
although the discrepancy between this and the degree of reaction
during the ultimate stage could be expressed as being 5 per cent.
7. Exaggeration and unequal alteration on both sides was al-
ways found in the initial stages of the disease, whereas the fre-
quency of abolition was proportionate to the progress of the dis-
ease ; during the first stage, decrease was more frequent than abo-
lition ; in the second, decrease was equal in proportion to abolition
in the initial stage, and twice less frequent in the third stage.
8. Marked decrease was never observed during the initial stage,
and it was of equal frequency during the two latter stages.
9. There is not one variety of mental disease in which all reflex
alterations could be found ; decrease is the most frequent, and ex-
aggeration was found mostly in the phase of mental expansiveness
or the mixed stages ; abolition was most frequent during the stage
of dementia ; decrease and abolition were in equal proportion dur-
ing the depressive and expansive stages, respectively ; finally, with
the exclusion of the stage of dementia, both pupils were generally
involved. The condition of calm or excitation seemed to have no
influence on the condition of the pupils.
10. The reflexes were always found to be abnormal in trau-
matic general paralysis ; next in order came alcoholism.
11. Exaggeration was found to exist when either syphilis or al-
cohol played a part in the disease ; abolition, which can be found
during the course of the disease induced by any cause, attained its
maximum outside of these two causes, and its minimum, — in alco-
holism ; in this latter, simple decrease predominated ; finally, trau-
matism only is apt to furnish one pupil with alteration while the
other remains normal.
*I2. The reflex was more frequently abnormal than normal at
all ages ; nevertheless, extreme age, and, as would be least expected,
202 WAR ON ALCOHOL.
marked youth, was more frequently associated with abnormality;
no statement can be made as to the definite action of either of the
extreme ages.
13. During the first two stages, the alteration of the reflex was
proportionate to the motor disturbances.
14. No correlation was noticed to exist between the light re-
flexes and the algesic sensibility ; this is not applicable to the tactile
sense; decreased tactile sensibility coincided with either abnor-
mality or abolition of the luminous reflex.
15. The study of the luminous reflex can serve as a guide in
doubtful cases, but it can furnish no indication regarding the rapid-
ity of evolution of the disease. {Gazette des Hopitaux, No. 30,
1902).
WAR ON ALCOHOL. — In an instructive historic review of
the spread of alcoholism DR. H. FOLET says that the beginning
of the rapid growth of alcoholism may be traced to the later half of
the XVIIIth century. England and America were then the lead-
ing countries in the consumption of alcohol. In the North, — Scan-
dinavia and Russia, the ravages of alcohol were particularly pro-
nounced. At an early stage, the distinguished physician of Stock-
holm, Magnus Iiuss, had already attracted universal attention to
his studies on the deplorable effect of alcoholic abuses on the Scan-
dinavian population. In 1852, he created the term alcoholism.
At that time he had gained the Monthyon prize of the French
Academy, for an essay on alcoholism, and the reporter on the prize
had occasion to remark : "Thank God, we have nothing of the kind
in our country." Toward the XlXth century, however, the intro-
duction of steam power had helped bring about the distribution of
various distilled alcohols throughout the country. At the same
time physicians had alarmed the nation by the idea that the gener-
ation was going through a period of anaemia. "Increase the blood"
was the war cry, "in order to warn off neuroses" (Sanguis Moder-
ator Nervorum). Meat and wine were the remedies prescribed
and various bitter tinctures containing alcohol to excess were
freely used, and medicated wines sprang up in innumerable varie-
ties. The worst alcoholic drink, however, appeared when absinthe
came into vogue. An old woman formulated well the relative evils
worked by simple alcoholic drinks and absinthe respectively, when
she said to the author : "When my husband came home drunk we
laughed at him ; but now — when my grandson enters the house in-
toxicated,— we tremble."
In France, the increase of cases of insanity due to alcoholism is
enormous, between the years 1866-1875, the number of such cases
CEREBRAL TUMORS.
203
was estimated as having been 713 yearly. In the year 1893, the
number of similar cases was 3,386. The round number of insane
cases for 1875 was 13,000; in 1897, it was double the preceding, —
26,000. The number of suicides has also almost doubled ; there had
been 5,400 in 1875, while there were 9,200 in 1896. The crimes
committed by alcoholics is progressively on the increase. Alco-
holism is also a great factor in reducing the vitality and in making
of an alcoholic a favorable subject for the development of pulmo-
nary tuberculosis. According to recent statistics by M. Jacquet,
71 out of 100 cases of tuberculosis treated in Paris hospitals are
alcoholics.
The amount of alcohol consumed in France has increased (from
1850 to 1897) from 1. 12 litres to 4.72 litres per capita, thus having
quadrupled in the course of 40 years ; Belgium equals France in
that respect ; Denmark, Holland and Germany equaled France, but
a diminished consumption has been observed in these countries
within the last ten years.
The consumption of absinthe in France was 18,000 hectolitres
in 1880; it was 168,000 in 1897, — more than 9 times more than it
was formerly. This amount is more than any consumed in the
rest of the world.
In 1878, Zola forsaw the ravages that threatened the country
from the abuse of alcohol ; he depicted these evils in most photo-
graphic terms in his Assommoir ; but even a masterpiece like that
cannot remedy such a growing evil.
THE REMEDY. — The schools are the places where the evil
should be nipped in the bud; the knowledge of the dangers in-
curred by the abuse of alcohol should be instilled into the child's
mind in a skillful manner during the day's instruction at school.
Woman's influence should be pre-eminent in this struggle, as she
has in her keeping all the manhood that is often allowed to remain
dormant in the boy.
A distinguished member of the Belgian Chamber of Deputies has
remarked, in this regard, that what woman wants ends by being
desired by the electoral body. (UEcho Medical du Nord, Feb. 9,
1902.)
CLINICAL AND HISTOLOGICAL FACTS IN THEIR
RELATION TO CIRCUMSCRIBED CEREBRAL TUilORS.
— DR. G. B. PELLIZZI publishes two cases of cerebral tumors.
In both much interest is attached to the clinical manifestations, in
their relation to the histological changes of the brain, as found
after death. In one case, the tumor was not suspected, as the pre-
dominant symptoms were those of progressive dementia, with an
204
EXTRACTS.
apoplectic attack as a beginning. The autopsy revealed the fact
that a tumor, the size of a hen's egg, had existed, presumably for
some years ; it was lodged in the frontal lobe and was adherent, in
some parts, to the meninges and the white substance. A consider-
able quantity of cerebral substance seemed to be destroyed. — The
second case was that of a man, 40 years of age, who was free from
any morbid heredity, but who indulged freely in alcoholic drinks.
He became subbject to epileptic attacks, which recurred monthly.
At the age of 43, after a severe fall, he found himself paralyzed in
the left arm. Four or five years later, when the arm was com-
pletely useless, the lower limb also showed signs of paralysis, of a
progressive nature; the foot was involved later, and a complete
hemiplegia was thus gradually developed. There was neither
cephalalgia nor vomiting, and the epileptic attacks recurred
monthly, as usual. The mental faculties remained intact. The
information obtained after death indicated that this patient had
suffered from a cerebral tumor. The onset of the monoplegia and
the gradual extension of the paralytic process should have sug-
gested the probability of the existence of a tumor in the brain, and
an operation might have saved the patient. The muscular con-
tractures of the paralyzed limbs were sufficient evidence of the
presence of a circumscribed cerebral lesion rather than of some
transitory circulatory disturbances. The onset of a brachial mon-
oplegia, preceded by epileptic attacks, and accompanied by them
at regular intervals, was sufficiently indicative of the presence of a
lesion of the middle area of the Rolandic convolution. Epilepsy
alone could not have been the cause of a monoplegia in the adult.
The two disturbances, as above described, may be met with in
infants ; the epilepsy is then due to special morbid conditions of the
brain, which differ from those in the case here considered. A
general analysis of the anatomical changes is made and compared
with the results of recent researches; a valuable bibliographical
list is appended to the article. (Rivista di Patologia Nervosa e
Mentale, Vol. VII., fasc. 1.)
EXTRACTS FROM " LE CRIME DANS LA FAMILLE."
by LOUIS ALBANEL. — Considering the workings of heredity in
the engendering of crime, the author calls attention to a point of in-
terest in this connection that is worthy of consideration. He an-
alyzes 600 families which have had criminal children brought be-
fore courts; 70 of these families are left out of consideration be-
cause they were only children. Thus, there remain 530 families
which had 2,250 children, or an average of 4 children per family.
Of this number there were 3 out of 4 who behaved well. As for
HYDROCEPHALUS. 205
the parents of these offspring, one-fifth had bad histories, one-
twentieth having been convicted of thefts, violence, drunkenness,
etc. How is one to account for the good morality of the ma-
jority of the children? the author asks. Are we to incriminate
atavism or idiosyncrasy? If so, why should these causes apply
partially in the same family? If the education is responsible in
these cases, then why did some children escape its bad effects?
One must conclude that the determining factors of criminality
are multiple as well as individual. One child is lost morally where
its brother remains safe. The case below is cited as an illustra-
tion:
A boy, 15 years of age, was arrested for repeated moral misde-
meanors of a grave nature. His father, who is a drunkard, has
also been guilty of monstrous conduct. The mother for-
sook her home to follow another man. In this family there was
another child, a girl, 17 years of age, who was brought up in the
same pitiable surrounding and who, like Fleur, in "Mysteres de
Paris," crushed by the ignoble life of those who surrounded her,
took refuge in a convent, so as to remain true to her honest senti-
ments, which had resisted the influence of the scandalous demor-
alization of which she was the sad witness. Both children claimed
the same degraded father and mother and yet only one was the
victim of the heredity, the surroundings and the education.
With these data in hand, it is evident that we should refrain
from upholding the theory that a fatal law of heredity regulates the
birth of criminals or geniuses. According to a statement by
Lombroso's distinguished compatriot, Enrico Ferri, Lombroso has
exaggerated the doctrine of heredity in order to attract attention
to it.
RERORT OF A CASE OF HYDROCEPHALUS (POSSI-
BLY ACQUIRED) WITH POST-riORTEn.— DRS. LOUIS
RASSIEUR and CARL FISH publish this case, stating that the
patient was a boy, 9 years of age, and that the family history was
negative, one brother and a sister being healthy. On May 20, 1901,
it was stated by the child's father that the disease had begun three
months previously and that the child began to show signs of blind-
ness a month after the onset of the disease. The main clinical fea-
tures observed some days before death were : severe pain in back of
neck, vertigo and cerebellar ataxia ; there was also a partial paraly-
sis of both arms and legs, and an optic atrophy. On May 24, a
lumbar puncture was made and 240 cc. of fluid was drawn. Death
took place on May 31. The autopsy revealed a marked dilation of
the floor of the third ventricle, the brain tissue was oedematous, the
206 CRUELTY IN CHILDREN.
cortex thinned, the convolutions flattened; the oedematous condi-
tion was most marked in the cerebellum ; the cedema did not extend
below the anterior portion of the medulla. Judging from the re-
sults of the microscopic examination, the affection is considered as
being of acute and idiopathic nature. Possibly the trouble was the
result of an inflammatory infection of the spinal leptomeninges,
which led to an obstruction of the communication between the
intra-ventricular and subarachnoid fluids. (St. Louis Med. Re-
view, March i, 1902).
At a meeting of the Belgian Neurological Society, Dr. Crocq
presented a case of typical acromegalia, of five years' standing;
there were no signs of gigantism ; there were marked mental dis-
turbances and signs of intracranial pressure. There were present
double optic neuritis, divergent stabismus and abolishes reflexes.
The author was of opinion that there was a tumor of the pituitary
gland in this case. (La Belgique Medicate, Jan. 30, 1902.)
CRUELTY IN CHILDREN DR. FOVEAU DE COUR-
MELLES considers the question of education during childhood
and says that too much time is given to the development of the
mental faculties and too little to the moral development. The
scientific treatises and discussions at Congresses never reach the
public; meanwhile, criminality and insanity are on the increase,
and no remedy seems to be provided against the growing evils.
Judges of leading courts, struck by the rapid growth of juvenile
criminality, are now devoting time to compilations of statistics con-
cerning this question of the hour, and many useful books have
been published by them for the use of the general public. A
question has been raised regarding the validity of literary publica-
tions in the form of novels, which deal with the subject above men-
tioned. There has been some strong criticism of MM. Poinsot
and Normandy's novel, — I'Echelle, which deals with this educa-
tional question of the young. The author of the article urges that
encouragement be given to similar writers, if it is desired to rectify
the moral cause of the growing generation. (Ann. de Medecine
et Chirurgie Infantile, March 15, 1902).
SUTURING OF NERVES — DR. RUOTTE reported to the
Surgical Society of Lyons, three cases of sutured ulnar nerves. In
all cases the results were satisfactory ; much interest is attached to
one case, in which the nerve remained divided until the wound
caused by the fracture of the wrist was completely healed. The
patient submitted himself to a second operation on account of the
impaired sensibility, movements and muscular atrophy which he
TREATMENT OF DEFECTIVES. 207
had noticed. The improvement in this case was slower than in
the others. (Gazette des Hopitaux de Toulouse, March 15, 1902)-
THE TREATMENT OF DEFECTIVES. —Dr. M. P. E.
GROSZMAN says in part that Prof. Monroe obtained data relating
to 10,000 pupils in California schools and found 10 per cent, men-
tally dull and 3 per cent, feeble-minded; there are many children
in public schools who could be more economically and wisely
trained in schools adapted to their special needs. There are
many more, nearly 10 per cent, of the whole public school en-
rollment, who should receive the thoughtful attention of teachers
and specialists. Mr. E. Dawson states that delinquent children
are below par in physical health as compared with the normal.
Judging from the broadness of the face that prevails in the crimi-
nal subjects, it may be inferred that they do not outgrow the in-
fantile characteristics. Special stress is laid on the fact that so-
ciety has not learned to apply preventive measures in cases of
criminality, as is done in those of dangerous diseases. ( The New
York Med. Jour., Febr. 1, 1902.)
From the Amer. Jour, of Insanity, Vol. L VIII.,. No. 3:
1. RECENT ADVANCES IN PSYCHIATRY AND THEIR
RELATION TO INTERNAL flEDICINE.— DR. STEWART
PATON : to-day the psychciatrist in the United States is in a posi-
tion similar to that in which Vesalius found himself when, owing
to the unfavorable conditions that existed at home, he was obliged
to carry on his work in a foreign country. In Europe^ the psychia-
trist has been given great facilities to educate himself by the state.
In Germany, Switzerland, France and Italy, the progress in the
study of psychiatry, when judged by standards as rigid as those
by which the work of other departments of medicine is estimated,
in no way suffers by comparison. In the United States, the stand-
ard of the internes of asylums for insane is much below that
found among the internes in general hospitals. In asylums, much
more frequently than in general hospitals, professionally incapable
men are appointed and retained. A pleasant personality, com-
bined with a pitiful lack of enthusiasm in matters relating to the
observation of patients and the study of their symptoms, is too fre-
quently considered a more essential qualification in a resident phy-
sician than is the possession of even moderate professional attain-
ments. Unquestionably, part of the dread which people often ex-
hibit in sending members of their families or friends to a hospital
for the insane has some foundation in the distrust entertained bv
20g HALLUCINATIONS AND ILLUSIONS.
physicians in regard to the professional capabilities of the resident
staff. This fear will not be removed until the same standard of
efficiency for medical work is established in our public or private
hospitals for the insane as that now demanded in the general hos-
pitals. The resident physicians tire of the clerical work imposed
on them and also lose all interest in their cases. The cases should
be studied individually and a thorough understanding should exist
between the pathologist and the ward physician, if good results are
to be obtained in psychiatry. The present policy in the asylums is
penny-wise and pound-foolish, hindering the progress of
psychiatry.
2. HALLUCINATIONS AND ILLUSIONS..— DR. GEORGE T.
TUTTLE : The results of an examination of 500 insane cases at
the McLean Hospital (222 men and 278 women), show that 189
(jj men and 112 women) had hallucinations or illusions of some
sort. Expressed in figures, this amount reached 37.8 per cent.
Munson reports 28.5 per cent, in 1339 cases. Lane reports 54 per
cent, in 307 cases. In the majority of cases the hallucinations were
those of hearing only ; next in frequency came those of sight and
hearing; after that, hallucinations of sight alone were observed.
Illusions may become contributive agents in the formation of
delusions.
Remarking on the popular conception of spiritualism and similar
doctrines, the author says that the false and exaggerated ideas
which characterize the beliefs of the adepts of those doctrines are
largely based on psychological phenomena that can be verified by
experiment. The hallucinations and illusions that come to those
subjects, while in an emotional condition, under the influence of
suggestion and expectant attention, are afterwards perpetuated by
habit. This seems to be the reason why so many persons, who
attempt to investigate spiritualism, become believers.
Seashore says that hallucinations and illusions of all the senses
could be induced in trained observers working in the laboratory,
sometimes even in spite of efforts to guard against them by giving
the observers warning. In experiments intended to show the per-
ception of heat, an apparatus was used in which a wire was heated
by an electric current. It took an appreciable time for an observer
to perceive the heat, and he was then expected to say "hot." Sev-
eral trials were made and the time taken. Then, unknown to the
observer, the trial was repeated without the current. After the
usual interval he almost invariably perceived the heat, although
none was generated. Visual hallucinations can easily be produced,
as is also shown by experiment. A blue bead, two or three milli-
NOTES ON INSANE. 209
metres in dilameter, was suspended in front of a black background.
The observer walked toward it until he saw the bead ; he then an-
nounced the distance at which he stood from the bead ; a tape on
the floor indicated that distance. After ten trials, the bead was
taken away without his knowing it, and as he repeated nearing the
place from which he had perceived the bead on previous occasions,
he announced that he saw the bead. About two-thirds of the per-
sons thus experimented on had hallucinations of sight. "They
knew when and where they should see the bead, and that was suffi-
cient to change the mental image into a realistic vision. " Similar
results were obtained in experiments on all senses. These hallu-
cinations are undoubtedly due to suggestions and expectant atten-
tion. Dr. Seashore remarks that if a scientific observer can thus
t>e led on by auto-suggestion, there can be no limit to the mental
fabrications of excited and imaginative persons, who find them-
selves under circumstances favorable to the creation of illusions.
It can only be supposed that the factors favoring the production
of illusions are due either to supersensitiveness or to overexcita-
tion of the sensory centres or to decreased inhibition. A decreased
degree of attention leads on to the onset of those abnormal phe-
nomena.
3, NOTES ON THE HEBREW INSANE DR. FRANK. G.
HYDE : The Hebrew, as a class, is hysterical and neurasthenic, as
reported in medical literature. These patients were chosen from
the total number of admissions, 17,135 (from Dec. 13, 1871, to
Nov. 30, 1900, inclusive), at the Manhattan State Hospital, East.
When at large, these patients generally live in conditions of physio-
logical misery. The influence of hospital life is very beneficial in
their cases, the recovery rate being good, when the subjects are
under the age of 30 years. The male Hebrew only is here ex-
amined. Of the total number of admissions as stated, 1,722, or
10.05 Per cent., were Hebrews. Examining the patients from the
date of the opening of the hospital, there are found J2 Hebrews
who give histories of syphilitic infection ; expressed in proportion,
that number amounts to 4.18 per cent, of Hebrew admissions.
This figure is low and shows that the Hebrews suffer less from this
disease than do Gentiles. Of the 1,722 cases admitted, 95, or 5.516
per cent., had a history of alcoholism. This figure is also low.
In order to compare these figures with some of more recent date,
a tabulation was made of the cases admitted during the five years
ending Nov. 30, 1900. There were 3,710 admissions during that
time, of which 573, or 15.44 per cent., were Hebrews. This shows
an increase of Hebrew admissions as compared with the figures
2I0 TRAUMATIC ENCEPHALITIS.
above cited. Of these 573 cases, syphilis was present in 5.58 per
cent, and alcoholism was present in 5.24 per cent. ; paresis was
present in 18.05 per cent. This latter form of insanity, while it
exists in a large percentage in the Hebrew race, is probably not as
high as the percentage obtained among the Gentile patients. Dr.
Savage stated in a discussion that in his experience paresis was a
disease not frequent in occurrence among the Hebrews, either
men or women.
4. TRAUJ1ATIC ENCEPHALITIS.— DR. HENRY P. FROST
publishes a case of traumatic encephalitis that was accompanied by
severe mental symptoms and epileptic seizures. The man was in
perfect health when he received a blow on the head. Headache and
epileptic attacks were the most prominent symptoms at first ; men-
tal disturbances set in later and the patient died after one year's ill-
ness caused by this accident. A thorough microscopic examina-
tion was made of the brain. The base of the brain was the seat of
apoplectic lesions; the temporo-sphenoidal lobes were the seats of
cerebral softening ; microscopically, other basal centres showed de-
generation of a hemorrhagic nature. The convulsions and mental
symptoms were directly due to basal lesions.
5. A REVIEW OF THE PATHOLOGICAL WORK DONE
IN THE H05PITAL FOR THE INSANE AT INDEPEND-
ENCE, IOWA — According to the report published by Dr.
Gershm H. Hill, the methods of investigation, pathological and
psychiatric, in the Iowa Hospital, are most modern and progres-
sive.
6. THE PATHOLOGY OF INSANITY.— DR. LOUIS PET-
TIT : A report is made of 56 autopsies performed at the Manhattan
State Hospital, East. The results are tabulated, and some re-
marks are made on the pathology of insanity. In conclusion it is
said that the symptoms of general paralysis are undergoing a modi-
fication; the delusions of grandeur are becoming less frequent in
occurrence and dementia seems to prevail as a clinical manifesta-
tion. Some cases seem to show tendencies towards self-limita-
tion.
7. A CASE OF IDIOPATHIC INTERNAL UNILATERAL
HYDROCEPHALUS WITH RECURRENT HErilPLEGIC
ATTACKS.— DR. WILLIAM CHARLES WHITE : The patient
was a colored woman, 74 years of age. In 1882, she was admitted to
the Central Indiana Hospital for Insane, suffering from maniacal
excitement. She was discharged in 1887, and was readmitted in
1891, suffering, as previously, from periodic spells of maniacal ex-
citement. In November, 1900, she had an attack of hemiplegia,
GLOBULAR RESISTANCE. 211
from which she recovered in 4 or 5 days. She had several such
attacks subsequently, and it was thought that she suffered from
cerebral embolism. The last attack was apoplectiform in nature ;
she fell to the ground, and when reached by an attendant she was
aphasic. Right hemiplegia set in on the following morning, uri-
nary incontinence and difficulty in swallowing complicating the
disease ; right hemianesthesia also took place. The patient died,
during this attack, from exhaustion caused by persistent diarrhoea.
The autopsy revealed the presence of an extensive dilatation of the
left lateral ventricle; hydrocephalus was the cause of the dilata-
tion.
RESEARCHES IN THE COflPARATIVE GLOBULAR
RESISTANCE IN THE AGED NORflAL AND INSANE
SUBJECTS.— DR. GIULIO OBICI concludes from his experi-
ments that : the average globular resistance of the blood in normal
subjects remains within normal limits until the age of 70. A mini-
mum resistance is characteristic of the advanced stages of senility.
Insanity of purely senile nature has no characteristic effect on the
changes of the blood corpuscles. An augmented average globular
reaction ma}' be found to exist in certain diseased conditions of
physical nature; an increased amount of young red cells accounts
for that phenomenon. In melancholiacs of the age of involution
there is a decrease of globular resistance (Rivista di Patologia
Nervosa e Mcntale, Vol. VII., fasc. 1.)
A CONTRIBUTION TO THE LOCALIZATION OF THE
flOTOR NUCLEI IN THE SPINAL CORD OF MAN DR.
ALEXANDER BRUCE publishes the results of microscopic ex-
aminations of various sections of the spinal cord, showing by illus-
trations that the cellular dispositions in the cord seem to be sys-
tematic ; this he demonstrates by the fact that in cases of reaction a
distance the affected areas are constant according to the abolition
of function caused by either atrophy or amputation of given mus-
cles. The article is illustrated schematically, and the works of recent
dates bearing on the subject are considered. {The Scottish Medi-
cal and Surgical Journal, Vol. IX., No. 6.)
DISTURBANCES OF VISUAL PERCEPTION, SYilPTOM
OF EPILEPSY. — PROF. RAYMOND, examining a case in
his clinic, called attention to a variety of disturbance of visual per-
ception met with in epileptics ; these sometimes complain of not see-
ing well, whereas, in reality they do see, but simply suffer from im-
paired visual perception: the gaze is vacant, but when asked to
212 STUMP HALLUCINATIONS.
read, the patients can do so, although insisting that their sight is
impaired. In such cases, epilepsy should be suspected ; bromide
treatment is always beneficial when epilepsy can be traced. The
second clinical case was that of
SURGICAL STUflP HALLUCINATIONS. — After an am-
putation above the elbow, of the hand and forearm, the patient suf-
fered from imaginary severe pain in the absent hand. When the
stump was pricked with a needle, pain was felt in various absent
fingers, according to the part pricked. Squeezing of the absent
hand also caused the patient pain. He was perfectly healthy and
had a negative history. (Journal de Medicine Interne, Feb. i,
1902.)
A CASE OF UR/EMIC POLYNEURITIS.— DR. CROCQ re-
ported this case, saying that the affection was due to ursemic intox-
ication ; although the patient had worked in a copper factory, the
disease should not be attributed to metal poisoning, because its
onset dates from a time long after the patient had left this occupa-
tion. According to Dr. Raymond, the etiology of multiple neuritis
comes under the headings of intoxications, auto-intoxications and
infections. (Bulletin de la Societe de Med. de Gand, Dec, 1901.)
TWO CA5ES OF EPILEPSY TREATED BY TREPHIN-
ING, WITH THE FORMATION OF A FLAP BY KOCHER'S
METHOD. — DR. I. CH. DZIRNE publishes these cases in
Chirurguia, stating that one patient has been an epileptic since
childhood, having from two to four attacks weekly and also being
crippled. Trephining was performed on the right side, and the
patient recovered the use of his left limbs ; after the operation the
attacks occurred in slight form and once a month. In the second
case there had been from three to four attacks daily for four years
preceding the operation ; after the operation the attacks had disap-
peared completely. (New York Med. Journ., March 1, 1902.)
A CASE OF ACQUIRED DEAF-ilUTISM.— The case is re-
ported in the Medical Press and Circular, by MAYO COLILER.
The patient, a girl nine years of age, began to lose her hearing
when three years old; the disease progressed steadily and when
seen by the author the child was absolutely a deaf-mute. It was
found that in each ear there was an occlusion of the canal by a thick
mass of cerumen that lay in close contact with the membrane. After
removal of that hard mass, and the use of a Politzer bag for a cer-
tain length of time, the child's speech and hearing improved;
CRETINISM.
213
while still under treatment, she could repeat some verses uttered
by her mother, whose lips were purposely hidden from view.
(Medical Record, March 8, 1902.)
CRETINISM. — DR. WALTER SANDS MILLS publishes a
case of cretinism, that set in when the patient was 4 years of age.
The case was neglected until she was 21 years old, when a physi-
cian administered to her thyroid treatment ; this was followed by
improvement; but when the treatment was suspended there was
a retrogression in her condition. The author calls special attention
to the fact that the suspension of the treatment was always fol-
lowed by bad results, the patient losing the mental as well as physi-
cal improvement derived from the treatment. The thyroid gland
may be implanted, and when absorbed, the operation should be re-
peated; the gland may be given by the mouth, or the various
extracts of the gland may be used. (New York Med. Jour., Feb.
22, 1902.)
THE PHYSICIANS' STRUGGLE AGAINST ALCOHOL-
ISM, — DR. H. TRIBOULET says that the present ineffectual
struggle against alcoholism is due to the indifference shown by the
physicians, who, above all others, should show more energy in this
matter than is expected of the layman. Of some 20,000 physicians
in France, only 500 are listed among the members of the anti-alco-
holic movement. The main reason for indifference among the
physicians is the fear of ridicule. In order to bear fruit, this strug-
gle against alcoholism should be entered into by all physicians ; a
medical temperance society should be formed, to which all physi-
cians of good faith in this matter should belong. As for their
present good faith, there are 4 or 5 medical deputies or senators
who have openly declared themselves in favor of bringing war on
alcoholism; the remaining 42 medical senators and 53 medical
deputies show their indifference in the matter. To paraphrase
Piron, one might say that "they are 95 with a conviction as if they
were 5 !" It is true that the revenue from alcohol is 500 million
francs annually, but the income is obtained at the precious expense
of the national moral and physical welfare. The sale of alcoholic
beverages should be limited, the leading physicians should head the
anti-alcoholic society and pamphleteering on the dangers of the
abuse of alcohol should become general. (Gaz. des Hopit., Feb. 15,
1902.)
PNEUflOCOCCUS ABSCESSES OF THE BRAIN. — M.
BOINET adds two cases of pneumococcus brain abscesses, which
are rare in occurrence, there being about seven such cases recorded.
214 CEREBRAL LOCALIZATION.
Abscesses of this nature are generally multiple ; when the abscess is
a single one it generally affects the left hemisphere. As a rule,
these abscesses are consequent on an attack of pneumonia, the cere-
bral infection taking place either during the stage of hepatization
or during that of resolution. Men are more frequently affected
than women, and those of middle age are more liable to suffer from
this disease; Reimer, however, recorded such a case in a child 6
years of age. In the author's case the cerebral abscess existed two
months, causing epileptiform attacks ; death followed when the ab-
scess opened into a cerebral ventricle. Trephining should be re-
sorted to as soon as the diagnosis of cerebral abscess is made. The
cerebellum may also be the seat of pneumococcus abscesses, al-
though they rarely occur without the cerebrum being affected at the
same time. The author cites a personal case of cerebral and cere-
bellar abscesses that followed a chronic and neglected otitis media.
(Gazette des Hospitaux de Toulouse, Jan. 18, 1902.)
THE CEREBRAL LOCALIZATIONS. — At the meeting of
the Societe de Biologie, Oct. 26, 1901, Ivl. PITRES made some re-
marks on a case reported, at a preceding meeting, by M. Dieulafoy ;
in that case, Jacksonian epilepsy had been caused by a lesion out-
side the motor area. This case does not shake the doctrine of
cerebral localization. As the case in question is one of a cerebral
tumor, one should be cautious in drawing conclusions from the
symptoms caused by it, as the symptoms are necessarily many and
varied, depending on pressure and irritation, making it difficult to
properly interpret the symptomatology. Charcot cautioned clin-
icians against drawing any conclusions in similar cases, so far as
cerebral localization was concerned, saying that no positive physi-
ological deductions could be made in such cases. M. Champinniere
remarked that a case like the one in question could be of diagnostic
value if trephined : the motor area would have been found hyper-
semic, and this would have been a point gained in the defence of the
doctrine of cerebral localization. The patient would have been
benefited by the operation, as the hyperemia would have been re-
lieved and specific treatment could subsequently have been em-
ployed. (Pro gres Medical, Nov. 16, 1901).
We learn with much regret that the Revue de Psychologie Clin-
ique et Therapeutique ceased to exist after its December issue of
1 90 1. It was a bright as well as an instructive publication, and
we can only express our sympathy with its able editors in having
found it necessary to bring the existence of this periodical to an
end.
CEREBRAL SYPHILIS.
215
LARYNGEAL, CEREBRAL AND AURICULAR SYPHILIS
CURED BY SPECIFIC TREATMENT.— PROF. H. DESPLATS
publishes this case. The patient presented herself for treat-
ment of the throat, she having completely lost her voice. Tuber-
culosis was at once suspected, but a closer examination revealed
the fact that the cicatrices on the vocal cords were distinctly of
syphilitic nature, and besides, there was ophthalmoplegia with
ptosis; there was also deafness. The history obtained from the
patient was wanting in information that could confirm the diag-
nosis, but specific treatment was instituted. The relief of the
symptoms was noticed a few days after the beginning of the treat-
ment, and the sight and hearing were completely restored within
the course of two months. The author surmises that besides a
gommata of the oculo-motor nerves, there were also lesions of the
Eustachian tubes ; the patient, indeed, claimed to have had ringing
in the ears. She was treated by a specialist for a year without
benefit, as he did not think of administering specific treatment.
(Jour. Des Sciences Medic. De Lille, Feb. 1, 1902).
1. INTESTINAL TUBERCULOSIS OF THE INSANE. —At
the January meeting of the Paris Academy of Medicine, DR. LAN-
DOUZY analyzed the work of MM. Anglade and Chacreux, in
which the fact is pointed out that intestinal tuberculosis is very
frequent among the insane housed in large numbers. There is a
great question of contamination to be considered in this respect,
which, up to the present time, has passed unnoticed.
2. At a meeting of the Neurological Society, M. Duval related a
case of a cerebral traumatism caused by the discharge of a bullet
from a revolver. The missile entered the skull at the region of the
right temporal, 6 centimetres above the tragus; after a period of
18 hours of coma, the patient presented a left brachial monoplegia,
sensory and motor, and difficulty in articulate speech as well as in
deglutition. An operation was performed and pieces of splintered
bone of the inner table of the skull were removed. By means of
the "X-ray" light it was found that the bullet had lodged in the
left side of the cranial cavity. Although there was destruction of
a large area of brain tissue, the patient was rid of the symptoms
above related, as soon as the surgical wound had healed. ( Gazette
des Hopitaux de Paris, Jan. 16, 1902.)
APHASIA. —At a meeting of the Societe de Bioldgie, Oct. 26,
M. TOUCHE presented the brains of three subjects who had suf-
fered from aphasia ; the insula was the seat of lesion in every case ;
such lesions seem to play an important role in aphasias, the author
stated. (Pro gres Medical, Nov. 16, 1901).
2i6 LUMBAR PUNCTURE.
LUflBAR PUNCTURE FOR CEPHALALGIA. -DR. R. C.
CARRIERE : In applying the treatment, the nature of the disease
must first be determined. Lumbar punctures were practiced by
the author in 4 cases of tubercular meningitis, which were accom-
panied by unbearable headache. In the last case, the headache
constituted the first symptom of the disease. Variable amounts
of liquid was drawn in these cases, by making lumbar punctures.
In all the cases? the liquid spurted out with force and was of nor-
mal consistency. The headache was relieved as soon as the liquid
had been drawn. In two cases, there was no remission of the
headache, while in the other two the headache reappeared, but it
was of less intensity.
Lumbar puncture was also practiced in a child, ^A years of age,
suffering from acute hydrocephalus and severe headache. The
liquid came out under marked pressure, 120 cc. being drawn. The
child calmed down and stated that it felt free from the headaches.
The trouble reappeared in the course of 48 hours, and a second
puncture was made, 100 cc. of liquid being drawn. The headache
disappeared, only to reappear three days later. As the third
puncture was being practiced, the child died in a marked convul-
sive attack. Seventy cc. of liquid was drawn.
A lumbar puncture was made in a child who suffered from
marked headaches caused by empysema of the frontal sinuses. The
liquid came out drop by drop, to the amount of 20 cc, but no
relief was thereby obtained.
In two cases of uraemia with intense headache the results of
the puncture varied ; in one case, only a few drops of fluid came
out, and the patient was not relieved ; in the second case, 90 cc.
came out under marked pressure, and the cephalalgia definitely
disappeared, the patient making a good recovery.
In one case, of presumable cerebral tumor, the operation gave
negative results ; this was also the case in one instance of anaemia
and in two cases of cephalalgia during adolescent growth.
Negative results were also obtained in one case of migraine,
while another case showed immediate improvement when 50 cc. of
fluid was drawn.
In another case, which was considered as being one of hysteri-
cal meningitis, relief was obtained after the withdrawal of 30 cc.
of fluid.
It is concluded that cephalalgia may be divided into two classes :
cephalalgia with normal tension and cephalalgia with high cere-
bral tension. In the latter case the withdrawal of fluid seems to
be beneficial, and may bring about a final cure ; repetition of the
operation may be necessary in some cases. Where the tension is
IMPULSES AND EPILEPSY.
217
normal the results are negative. (Le Nord Medical, March 15,
1902).
A CASE OF EPILEPTIC PSYCHIC DISTURBANCE AND
MORBID IMPULSES DURING THE EPILEPTIC STATE.
—DR. A. EBERSCHWEILER: An epileptic patient manifested
morbid impulses to cut the clothes to which she had access; this
impulse generally overtook her just before or immediately after
an epileptic attack. As she destroyed a large quantity of clothes
by cutting them with an instrument, the case came up for legal
consideration. She admitted that she was perfectly conscious of
her deeds and that she remembered having committed them.
(Aerztliche Sachverst. Zeitung, VIII., No. 6. 1902).
XIVTH INTERNATIONAL CONGRESS OF MEDICINE,
Madrid, 23-30 April, 1903. Active preparation are being made
for the XlVth International Congress of Medicine to be held at
Madrid, April 23-30, 1903.
The Spanish Minister of Foreign Affairs has sent out invita-
tions to all Governments, asking them to delegate their repre-
sentatives; the various medical schools and Societies have also
been similarly invited. The Secretary of the Congress has re-
ceived, up to this date, the names of 85 delegates.
Necessary steps have already been taken to secure reduced rail-
road and steamship rates.
Members are asked to join and send in the subscription fee at the
earliest possible moment. The membership fee is 30 Pesetas, and
checks for that amount should be addressed to the Secretary of the
Congress, University of Madrid, Spain.
The various sections in medicine will be as follows :
1 — Anatomy (Anthropology, Comparative anatomy, Embryol-
ogy, Descriptive Anatomy, Normal histology and Teratology).
2 — Physiology, Physics and Biological chemistry. 3 — General
pathology, Pathological anatomy and Bacteriology. 4 — Thera-
peutics and Pharmacy: a, therapeutics; b, medical hydrology; c,
pharmacy. 5 — Internal medicine. 6 — Neuropathology, Mental
diseases and Criminal anthropology. 7 — Pediatrics. 8 — Derma-
tology and Syphilography. 9 — General surgery : a, surgery and
surgical operations; b, urology. 10 — Ophthalmalogy. 11 — Oto-
Rhino-Laryngology. 12 — Odontalogy and Stomatology. 13 —
Obstetrics and Gynecology. 14 — Medecine, Military and Na-
tional Hygiene. 15 — Hygiene, Epidemiology and Technical san-
itary science. 16 — Legal medicine and Toxicology. (Pr ogres
Med., March 15, 1902).
2l8 SEVERING OF THE VASA DEFERENTIA.
THE SEVERING OF THE VASA DEFERENTIA AND ITS RELA=
TION TO THE NEUROPSYCHOPATHIC CONSTITUTION.— DR.
H. C. SHARP: The influence of degenerate heredity is far reaching and
can be found not only among the insane and criminals, but also among
geniuses. Chatterton, Goldsmith, Burns, Steele, Coleridge, Charles Lamb
and Cowper rank among the descendants of such heredity. Coleridge's
father was an opium eater, and he himself had psychic stigmata of degen-
eracy. Some geniuses however, had healthy heredity (Aristotle, Bacon,
James Watt, Addison, Thomas Arnold, Macau! ay and Mme. de Stael. John
Adams, the second American President, and his descendants for a number
of generations were distinguished persons). Morbid heredity seems to be a
powerful factor in increasing and perpetuating criminality and insanity. In
1850, there were 6,737 criminals in the United States, or one to every 3,442
of the population ; while in 1890, the penal population is shown to be 83,329,
or one to every 957 of the population. These show the proportion of the
criminal subjects only. If all dependents were considered, such as inhabit
public and private insane hospitals, almshouses and institutions for the
feeble-minded, we should find the proportion to be in the neighborhood of
one to 300 of the population. The human species alone, among living crea-
tures, supplies such a high percentage of invalid members; in the animal
kingdom, the criminal subjects are destroyed by their equals. We should
lessen the propagation of criminal and insane subjects by rendering them
sexually impotent. Dr. F. Hoyt Pilcher, superintendent of the Asylum for
Idiotic and Imbecile Youths, of Kansas, castrated 47 of his inmates and
alleged to have thereby obtained a marked physical and mental improve-
ment of the patients; one case he considers as particularly benefited, as he
is at large now and gains his livelihood as a farm-hand.
The author prefers to employ a different method with the same end in
view: he suggests as a simpler method that of ligating the vasa deferentia.
He performed this operation in 42 patients, whose ages ranged from 17
to 25, and he is quite positive that mental and physical improvement re-
sulted therefrom. A case is cited as being typical. He advises that the
legislature be urged to enact laws restricting marriages in undesirable
instances and empowering medical heads of institutions to exercise their art
with a view to lessening the possible descendency of invalid subjects. {New
York Med. Journal March 8, 1902.)
TWENTIETH CENTURY METHODS OF PROVISION FOR THE
INSANE. — Dr. Frederick Peterson, addressing the State Conference of
Charities, at New York, gave a historical sketch of the methods employed
for the treatment of the insane. The latter part of the XlXth century was
characterized by the establishment of Asylums for the insane, as contrasted
with the chain and dungeon system of the preceding era. The XXth cen-
tury is marked by a further and more progressive movement in behalf of
the insane; in the United States, attempts are being made to provide for
the acutely insane in psychopathic hospitals, and colonies are advocated
for the housing of mixed cases and the chronic insane. In Europe, these
methods are partially realized, especially so in Germany. Much stress is
laid on the necessity of doing away with the large asylum structures and of
building cottages in their place. The excessive herding of patients in the
large asylums is considered detrimental to their recovery. The cottage sys-
tem is more conducive to intimate relations between attendants and pa-
tients ; this is an important factor in the matter of recovery. Emergency
GOETHE; HIS DESCENDANTS. 219
hospitals for the reception of the insane should be founded in New York
and Brooklyn ; at present, there are many instances of insane cases being
taken to police station houses before they are placed in the insane pavilions.
Discussing the theories advanced by Dr. Peterson, Dr. Carlos F. Mac-
Donald said that he did not endorse the idea of small psychopathic hospitals
in the cities, as better curative results are to be obtained by treating such
cases in the country. He also objected to a strict division of acute and
chronic cases : the patients become discouraged when aware of the fact that
they are considered chronic cases, and from an administrative point of view
it is convenient to have the chronic cases do work in the wards for the acute
patients. He also objected to the movement in favor of relieving the asylum
superitendents of the business administration of the asylum, because medical
men make good business men as well.
Tubercular cases are isolated in tents in the Manhattan State Hospital.
The training schools for nurses in the various State hospitals are a success ;
last year 187 trained attendants graduated from the schools.
The State institutions for the care of the feeble-minded and epileptics are :
Syracuse State Institution for Feeble-Minded Children, accommodating 550
subjects; Newark State Custodian Asylum, 460; Rome State Custodial
Asylum, 550, and Craig Colony for Epileptics, 840; total, 2,400. There are
1,642 feeble-minded and epileptic subjects maintained in various almshouses
in the State; there are some 5,257 additional feeble-minded, idiotic and
epileptic subjects scattered throughout the State, in various orphan asylums
and other institutions not adapted for the treatment of those cases. The
importance of providing suitably for the cases considered may be more
vividly realized when we are informed that in the Syracuse Asylum 23 per
cent, of the feeble-minded women have given birth to children before ad-
mission to the Institution. Practical recommendations were made with a
view to lessening the propagation of the feeble-minded; proper
sequestration was suggested as being the most effective measure.
The discussion was finally concluded by some comparative con-
siderations regarding the care of the insane under the "Wisconsin System"
(county care of the chronic insane) as compared to the State care, practiced
in New York; a historic sketch was then given of the Institutions for the
mentally defective, who were sentenced for crime. Auburn was the first
Institution, in New York State, erected in 1855; Matteawan followed in
1892, and Dannemora was the last one built.
The State of New York has invested for hospitals, plants and equip-
ments for the insane, upwards of twenty-five million dollars; the support
of the hospitals involves an annual expenditure of from five to six million
dollars. — (Amer. Jour, of Insanity, Jan., 1902.)
THE DEATH OF GOETHE. HIS DESCENDANTS.— Analyzing
the work of Goethe, in "Pathologique dans Goethe," by Dr. Moebius, Dr.
Paul Cornet says in part: The poet suffered from nervous affections at
various times. He died in a delirious condition, March 22, 1832. His de-
scendants were pathological subjects; it seems that the Evil one wished to
"make up" for the extraordinary happiness which gratified the great man,
the author remarks. Mme. Goethe, the poet's wife, is considered first. She
was an orphan, born of an alcoholic father. As she had lost her parents
when a child, she had to work for her living, and was employed in a feather
factory. She was beautiful, a good housekeeper, but very sensual and pas-
sionately fond of dancing; to gratify this inclination, she frequented the
220 PRESENTIMENT OF HEINE'S DEATH.
students' balls. She then acquired an immoderate taste for wine, accord-
ing to her hereditary predisposition on the paternal side. She died when
52 years of age, from alcoholic epilepsy ; uraemia is also claimed to have
been the cause of her death. She married Goethe in 1788 and gave birth to
a son, named August, in 1789. In 1791 she gave birth to a second male
child, which was still-born; in 1793 a girl was born, who died 10 days later;
in 1795 a third son was born who died 15 days later; in 1802 a girl came
into the world still-born. The only child surviving, August Goethe, was
handsome and well-developed but he early acquired a taste for alcoholic
drink. In 1817, he married Otillie de Pogwitch, and the union was an
unhappy one ; the young wife was a degenerate, excessive, unstable and
phantastic. The young alcoholic husband led a sad existence and died
when 40 years old; there is some mystery regarding his death, as vari-
ous causes are said to have ended his life ; among those mostly admitted
are : Syphilis, scarlatina and apoplexy, following a cerebral lesion, due to
progressive paralysis. The record of the autopsy states that his liver was
three times the usual size. Rumor has it that he committed suicide in Rome.
There were three children born from this unhappy union : Walter Wolf-
gang, in 1818; he was undersized, sickly and died of pulmonary tuber-
culosis, in 1885. Wolf, the youngest, born in 1820, was ungovernable, phan-
tastic, although serious minded and secretive ; he was sickly, suffering from
rheumatism, general physical debility and asthma ; he died during a spell
of this latter illness, in 1883. A girl, Alma, was born in 1827 and died of
typhus fever, in 1844.
CONCLUSIONS : The author of "Pathologique dans Goethe" gives no
new information by telling us that genius borders on the pathological.
Credit should be accorded him, however, for the conscientious analysis of
psychological and psychiatric questions relating to the poet's works. Dr.
Moebius's enterprise in such work, relating to great men, should be emu-
lated by others. (Progres Medical, March 15, 1902.)
A HISTORIC CASE OF TELEPATHY: PRESENTIMENT OF HEN-
RI HEINE'S DEATH BY ONE OF HIS FRIENDS.— The Gazette Medi-
cate de Paris, March 15, 1902, commenting editorially on the psychological
phenomenon commonly called telepathy, says that in the case of Heine and
his friend, M-me Selden, between whom an intimate friendship and sym-
pathy existed, the manifestation may easily be explained on scientific
grounds. M-me Selden was devoted to the poet; it is a known fact that
people who are devoted friends generally have an intuitive knowledge each
of the other's physical condition. It is quite natural, therefore, that M-me
Selden, who eagerly watched over her friend during his last illness, should
have felt that his strength was waning and that death was impending. Ac-
cording to her memoires, she had a presentiment of his death on the very
morning he died, although she was away in her own house, quite a long
distance from the place where he died.
She describes her presentiment as follows :
"Near eight o'clock in the morning, / heard a noise, resembling that pro-
duced by the movements of the wings of a butterfly. I opened my eyes,
but shut them again : a black form, resembling a giant insect, writhed be-
fore me."
She hurried to the bedside of Heine, and on arriving there found him
dead.
BOOK REVIEWS. 221
The transitory visual and auditory hallucinations in this case, the author
remarks, are perfectly compatible with the frame of mind of this intellectual
and highly nervous person.
GENIUS AND WORK. — From the various records relating to great
men we generally learn that they were incessant workers. Thus, Victor
Hugo's grand-son is said to have related, according to the Gazette des
Hopitaux de Paris, that the poet and novelist never ceased working; his
bed was so arranged that he could work, without leaving it, at any hour
through the night; there were books and references at hand, on shelves
around the bed, so that economy of time could be practiced and work ac-
complished.
BOOK REVIEWS.
VORLESUNGEN UEBER DIE PAT HO LOG ISC HE
ANATOMIE DES RUECKEMARKS.— UNTER MITWIR-
KUNG VON DR. SIEGFRIED SACKI, NERVENARZT IN
MUENCHEN HERAUSGEGEBEN VON HANS SCHMAUS,
A. O. PROFESSOR U. I. ASSISTENT AM PATHOLOG.
INSTITUT IN MUENCHEN. MIT. 187 TEILWEISE FAR-
BIGEN TEXTABBILDUNGEN. VERLAG VON J. F. BERG-
MANN, WEISBADEN, 1901. The subjects treated of in this
volume are : Secondary degenerations of the spinal tracts,
general consideration of the nerve cells, — their reaction and
degenerative forms ; general consideration of the degenera-
tion of the nerve fibres ; tabes dorsalis, degeneration of
the nervous motor system, circulatory disturbances of the
spinal cord, acute myelitis and other forms of myelitis,
complex degenerations of the spinal tracts, traumatisms,
concussion, tubercular and syphilitic diseases of the spinal cord ;
developmental and congenital defects, syringomyelia and tumors
of the spinal cord. Wherever the subject requires, a thorough
description of the histology, embryology, physiology, pathology
and schematic representation of functions of the elements of the
spinal cords are given; a profusion of excellent illustrations by
uni- as well as by multi-colored plates of the highest possible
grade enhance the value of this volume. The thoroughness with
which this text-book has been presented cannot possibly be im-
proved on. The volume embodies the fruits of many years of
sincerest scientific research in the pathology of the spinal cord, the
latest discoveries in the study of this subject being presented. It
222 BOOK REVIEWS.
is, without any doubt, the most valuable work on the spinal cord
known to-day. The text contains 589 pages ; 25 pages are taken
up with a bibliographical index and a thorough index to the sub-
jects treated of takes up 30 pages. The author deserves the sin-
cerest congratulations on this splendid achievement.
SOUDEBNAJA PSYCHOLOGUIA. — VLADIMIR SERB-
SKI, Privat-Docent, University of Moscow. M. S. Sabash-
nikovi, Moscow, 1900. Prof. Serbski does not need any intro-
duction to the medical public; he has made his name familiar to
every psychiatrist as a thorough clinician. The present volume
is the second edition of his complete course in psychiatry, deliv-
ered at the University of Moscow. He entitled his work "Legal
Psychiatry," because he treats of mental diseases in their relation
to legal medicine. A good part of the volume is devoted to the
study of the psychology and psychiatry of the special and the gen-
eral senses and the judgment; a classification of the mental dis-
eases follows and the second part of the text is taken up with in-
dividual psychiatry, hypnotism from a medico-legal standpoint,
and simulated insanities. It is a handsome volume of 481 pages
and a translation of this would be a valuable addition to our litera-
ture on psychiatry.
RECHERCHES CLINIQUES ET THERAPEUTIQUES
SUR L'EPILEPSIE, LHYSTERIE ET L'IDIOTIE. Compte-
rendu du service des enfants idiots, epileptiques et arrieres
de Bicetre, pendant l'annee 1900. Bourn eville. With the col-
laboration of Drs. Crouzon, Dionis du Sejour, Izard, Laurens,
Paul-Boncour, Philippe and Oberthur. Volume XXI, with 19
figures and XI plates. Progres Medical, or Felix Alcan, Paris.
Dr. Bourneville is increasing, from day to day, the valuable clini-
cal, psychiatric, macroscopic and microscopic studies of the cases
treated at the Bicetre Asylum. Every report, which he publishes
under the above mentioned title is replete with scientific studies
which he directs and to which he contributes himself. The value
of such reports cannot be overestimated in the domain of psy-
chiatry, where all knowledge rests on the completeness and thor-
oughness of the individual histories obtained. Every history is
carefully kept and every anatomical specimen is duly placed in the
Anatomical Museum of the Institution. Students and psychiatrists
find valuable material in these histories and the corresponding
anatomical specimens. This volume should be particularly
perused by superintendents of Hospitals for the Insane, who have
BOOK REVIEWS. 223
not, thus far, succeeded in tintroducing a thorough method of sys-
tematic study of the degenerate. The report contains a detailed
account of useful pedagogic methods for the treatment of the de-
generate and numerous illustrations, both of anatomical speci-
mens and of practical methods in vogue at the Bicetre asylum. The
volume contains 236 pages.
MONOGRAPHIES CLINIQUES, 29. LBS PONCTIONS
RACHIDIENNE ACCIDENTELLES et les complications des
plaies penetrates du rachis par armes blanches sans lesions de la
moelle. Dr. E. Mathieu, Masson, et c-ie, Paris. The principal
results of this study are the following: 1, penetrating wounds by
cold arms of the spinal column, without lesions of the spinal cord,
are not dangerous ; when uncomplicated, the wounds tend towards
spontaneous healing; 2, vertebral lesions ( osteo-periosteal and
osteo-articular) have a serious effect on the course of the disease;
3, in the first variety, — congestive meningeal complications are to
be feared; in the second, when the bones are involved, purulent
complications may take place and even extend to the brain ; 4, the
duration of the disease is uncertain, but antiseptic treatment is of
the greatest value and is aided by the flow of the cerebro-spinal
fluid, which washes off the infected parts ; 5, difficult complications
arise from implications of the anterior part of column, where
treatment cannot be directly applied; finally, 6, vascular disturb-
ances are apt to cause trouble, if they set in.
LA MIGRAINE et son traitement. Dr. Paul Kovalevsky.
The causes, clinical course and prognosis of migraine are consid-
ered in detail. The author admits, with other neurologists, that
heredity plays an important role in the causation of this disease,
but he is not a believer in the fatalistic consequences of such
agencies as heredity ; his experience leads him to believe that ra-
tional treatment is of great clinical value in these cases.
CONGRES INTERNATIONAL D'ANTHROPOLOGIE
CRiniNELLE. COMPTE RENDU des travaux de la cin-
quieme session tenu a Amsterdam, 9-14 septembre, 1901. Edited
by Professor J. K. A. Wertheim Salomonson, general Secretary
of the Congress. The volume has 529 pages of original con-
tributions to the science of criminal anthropology. Coming from
the pens of the leading psychiatrists, jurists and anthropologists of
the day, these contributions, grouped in one large volume, are of
inestimable worth to the scientist. The editor of this important
work deserves particular credit for the handsome appearance of
the report.
224
BOOK REVIEWS.
LETAT MENTAL DBS PARRICIDES. Etude Medico-
Legale. These de Bordeaux. Dr. G. Asselin. Conclusions: i. —
crimes like parricide and other grave violences against parents
are comparatively frequent in occurrence. According to Lacas-
sagne, these crimes furnish 1/37 of all the crimes of assault; 2.—
the parricides are almost invariably degenerates ; the degree of de-
generacy in these subjects is often so apparent that one may say,
with Dr. Regis, that the crime of parricide is a crime of a degen-
erate; 3. — the most important psychic stigmata of degeneracy in
these subjects are impulsiveness and lack of affection; alcoholism,
epilepsy and delirii in these subjects may act as accessory agents in
the process of effecting such deeds ; cupidity often seems to be the
only cause of this crime ; but in reality this is only an exciting
cause ; degeneracy is the fundamental cause ; 4. — of 63 cases of par-
ricides examined by the author, 30 were adjudged insane and are
inmates in asylums ; a large number of those condemned for the
crime were granted commutation of sentence and only 6 of these
subjects were sentenced to capital punishment; this fact proves
that the degeneracy of the act is self evident even to those who
are not psychiatrists; if more careful investigation of this subject
were made, there would be more of them sent to the asylums and
less would be condemned to imprisonment or capital punishment ;
5. — special asylums should be founded for degenerates of this char-
acter.
BOOKS AND PAMPHLETS RECEIVED.
Prof. P. I. Kovalevsky. EPILEPSIA, YEIA LETCHENIE I SOU-
DEBNO-PSYCHIATRICHESKOYE ZNACHENYE. 3d edition. Akin-
fief and Leontief, St. Petersbourg.
PROCEEDINGS OF THE AMERICAN MEDICO-PSYCHOLOGI-
CAL ASSOCIATION, 57th annual meeting, Milwaukee, Wis., June 12, 13,
14, 1901.
Dr. Alfred Fuchs. ZUR FRAGE NACH DER BEDEUTUNG DER
REMISSIONEN IM FERLAUFE EINZELNER FORMEN VON
ACUTEN PSYCHOSEN.
Dr. L. Cappelletti. IL TRATTAMENTO FAMIGLIARE DEI MA-
LATI DI MENTE.
Prof. Paul Kovolevsky. EPILEPSIE, TRAITMENT, ASSISTANCE
ET MEDECINE LEGALE. Vigot freres, 1901, Paris.
Dr. William Littleton Robins. EINE STUDIE UEBER POST-
AMTSVERBRECHER.
Dr. Moriz Infeld. BEITRAEGE ZUR KENNTNISS DER KINDER-
PSYCHOSEN.
Prof. Serge Soukhanoff. CONTRIBUTION A L'ETUDE DE LA
MALADIE DE KORASAKOFF. Un cas de polynevrite avec psychose
polynevritique post-typhoidique.
Dr. Heinrich Stern. ON THE TREATMENT OF OBESITY.
Drs. Cappeletti and A. D'Ormea. LA DIETA IPOCLORURATA
NELLA CURA BROMICA DELLA EPILESSIA.
Dr. P. Serieux. LA STATISTIQUE DES ALIENES DE CANTON
DE ZURICH.
CONGRES INTERNATIONAL DE L'ASSISTANCE DES
ALIENES ET SPECIALEMENT DE LEUR ASSISTANCE FAMILI-
ALE. Anvers, 1-7 Septembre, 1902.
CONGRES D' ASSISTANCE FAMILIALE, 27-31 Octobre, 1901.
Vol. II.
Wwft^OftV.
No. 5.
The Journal of
Mental Pathology
Subscription Pf ice : — $2*50 per annum*
Single Copies, 50 cents*
Edited by Louise G. Robinovitch, B. is L., M.D.
Editorial Board
Dr. V. MAGNAN, Dr. A. JOFFROY, Dr. F. RAYMOND (Paris), Dr. CHAS. K. MILLS (Phila.),
Dr. JUL. MOREL (Belgium), Dr. E. R&GIS (Bordeaux), Dr. G CESARE FERRARI. Editor Rivista
Sperim. di Fren. (Italy).
ALBANEL, L., LL. D., Pre
BAJENOW, Dr., (Moscow);
BLEULER, Prof. E. (Zurich)
cian Bicetre Asylum, Editor P,
to the Asylums of the Seine;
(Bernares, India); CLAPARE
(Parife) ; BAILEY, Dr. P. (New York) ;
BERILLON, Dr. Edgar (Paris);
, BOURNEVILLE, Dr., Chief Physi-
N. (Roumania); BRIAND, Physician
icine (Paris); CHATTERJI, Mr. J. C.
ns/de Psychologie (Switzerland); CROCQ,
itri, LL. D., Jurist Ministry of Justice
General Council (Russia); DAGONET, Dr.;
Prof., Editor Journal de Neurolgfo^tBElgtyvx)^ E
(Russia) ; DEKTEREW, Dr. W. de, Memfc'eijlftinic
FAURE, Dr. Maurice; FERRI, E., LL. D., Deputy (Rome, Italy); FAREZ, Dr. Paul; GREIDENBERG,
Dr. B. S. (Russia) ; GARNIER, Dr. P., Expert at the Tribunal (Paris) ; JANET, Dr. (Paris) ; KOPOS-
SOW, Dr., Superintendent Simbirsk Asylum; LALANNE, Dr.; LANGELAAN, Dr. J. W. (Holland);
LEGRAS, Dr.; LEGRAIN, Dr.; LOURIE, Ossip, Ph. D. (Paris); MARRO, Prof., Dir. "Annali di
Freniatria" (Italy); MARIE, Dr. Auguste, Chief Physician Villejuif Asylum; MARINESCO, Prof. G.
(Roumania); MARTIN, Dr. E. (France); MEDICI, Dr.; MacDONALD, Dr. A. E., Superintendent
Manhattan State Hospital (New York); NAMMACK, Dr. Ch.; NEISSER, Dr. CLEMENS, Chief
Physician of the County Asylum, Leubus (Germany); OBICI, Dr. (Italy); PETERSON, Dr. F., Com-
missioner in Lunacy, State of New York; PIERON, Dr. H., Preparateur Laboratory Experim. Psych.,
School of Higher Studies (Villejuif ); PHILIPPE, Dr. CI.; REGNARD, A., Ministry of the Int.,
(Paris); REIS, Dr. Mello (Brazil); ROBERTSON, Dr. F. W., General Superintendent Elmira Reform-
atory; REY, Dr. Philippe, Superintendent Public Asylums (Aix) ; RITTI, Dr. Ant., Chief Physician
Charenton Asylum; SEMELAIGNE, Dr. Rene; SEMIDALOW, Dr. B. (Russia); SERIEUX, Dr. P.
(France); SERGI, Prof. G. (Italy); SINANI, Dr. B. N. (Russia); SERBSKI, Dr. V. P. (Moscow);
SNELL, Dr.; SOUKHANOFF, S., PrKat. Docent, Univ. Moscow; SPITZKA, E. A. (New York);
STOENESCU, Dr. N. (Roumania); TATY, Dr. (France); TSCHISCH, W., Prof. (Russia); TREVES,
Dr. Marco (Italy) ; TOULOUSE, Dr. E., Chief Physician Villejuif Asylum, Director Laboratory Exper.
Psych., School of Higher Studies; TRUELLE, Dr.; VAN DEVENTER, Dr., Dir. Meerenberg Asylum,
Holland; VAN HAMEL, G. A., Prof. Criminal Law, Univ. Amsterdam; VURPAS, Dr. CI., Asylums of
the Seine; VAN GIESON, Dr. Ira T.; VALLON, Dr. Physician to Ste. Anne, Expert at the Supreme
Courts (Paris); VASCHIDE, Dr. N., Chef des Travaux, Laboratory Exp. Psychol. (Paris); VOISIN,
Dr. Jules, Physician to the Salpetriere (Paris); WINKLER, Dr. C.,Univ. Amsterdam.
STATE PUBLISHING COMPANY
290 Broadway, NEW YORK, N. Y.
TABLE OF CONTENTS.
LEADING ARTICLES.
A Case of Transitory Aphasia due to Traumatism, Prof. Fasola 225
Studies of Morbid Obessions, Drs. Soukhanoff and Gannoutchkine . .. 238
Pure Verbal Deafness, Drs. VanGehuchten and Goris 253
The Genesis of Epilepsy Clinically Considered. The Pathology,
Prophylaxis and Treatment of Epilepsy, Dr. Robinovitch 264
EDITORIAL.
Philosophic Research versus Reality 267
TRANSLATIONS AND ABSTRACTS OF CURRENT LITERATURE.
Methods for the Re-education of the Dements 270
Etiology of Paresis 270
Some Observations on the Elimination of Indican, Acetone and Dia-
cetic Acid in Various Psychoses 271
A Case of Feigned Insanity 272
A Case of Cholesteatoma of the Brain 272
Cerebral Tumor with Autopsy 274
Akatesia 274
The Trophedemas 275
Cerebral Porosity 275
Proceedings of the Society of Hypnology and Psychology 277
BOOK REVIEWS.
Die Koerperlichen Erscheinungen des Delirium Tremens. Klinische
Studien. Dr. August Doellken. Verlag von Veit, Co., Leipzig. . 278
Epilepsie, Traitement, Assistance et Medecine Medico-legale. Prof.
Paul Kovalevssky. Vigot freres, 1901, Paris 278
Epilepsia, Eia Letchenie i Soudebno-psychologuitcheskoe Znachenie
Prof. Paul Kovalesky 279
Transactions of the American Medico-Psychological Association, 1901 279
Le Mystere Posthume, Dr. Li Tai 279
De la Valeur Clinique du Cytodiagnostic Cephalo-Rachidien dans les
Cas Douteux de Paralysie Generale Progressive. Dr. Maillard 279
Le Delire d' Auto-Accusation, Dr. P. Oudard 280
Considerations Psychologiques et Medico-Pedagogiques sur un Cas
de Degenerescence 280
Books and Pamphlets Received 3rd cover
The Journal of Mental Pathology.
Vol. II. JUNE, 1902. No. 5.
A CASE OF TRANSITORY APHASIA DUE TO
TRAUMATISM.
BY PROF. G. FASOLA, Royal University, Cagliari, Italy.*
Although the classic works of Broca, relating to the localization
of the centre of speech, were followed by an accumulation of sta-
tistical cases, which has shed some light on the subject, our knowl-
edge of the question still remains insufficient; our knowledge is
particularly deficient in regard to the understanding of the com-
plexity of speech disturbances and that of the anatomical distribu-
tion and relation of the centres which govern speech. The data
furnished by surgical cases become, therefore, most valuable and
are carefully studied and collected.
In the references at my disposal, I have been able to find only
two cases in which surgical interference was followed by more or
less durable disturbances of speech. Both are described in Chirur-
gie operatoire du systeme nerveux, A. Chipault, tome II, Paris,
1895, and I shall mention here only those points, which have a bear-
ing on our subject.
Case 23, page 697. — Drs. Mitchell and Keen. Extirpation of the Gas-
sirian ganglion in a subject 41 years of age, to relieve a painful tic of 13
years' standing. The operation was performed in October, 1893. "While
the middle lobe was being lifted, a considerable hemorrhage took place,
which necessitated tamponing and a delay of the operation. There was no
shock ; during the following few days, there was slow respiration ; a slight
degree of aphasia, although the tampon was applied on the right side ; the
painful spells persisted. The tampon was carefully removed three days
after, and the operation was successfully completed."
Referring to the results, it is stated: "The patient left the sick-bed, and
the wound was healed ; the aphasia diminished rapidly. Cure."
Case 39 p. 706. Dr. Roberts. Intracranial neurotomy of the 2d and 3d
branches of the Vth, immediately behind the Gassirian ganglion; man, 76
years of age ; neuralgia of old standing of said branches.
The operation was performed Nov. 5, 1892. Eighteen days after the op-
eration: It was noticed that the patient could not give the name of the
city nor that of the hospital physician ; it is, no doubt, an aphasic phenom-
enon, although very slight in degree."
^Simultaneous publication in the Rivista Sperimentale di Freniatria.
The exact date of publication in Italy is not certain.
226 TRANSITORY APHASIA.— Prof. Fasola.
It is not mentioned on which side the operation was performed, but the
following is mentioned in the description : "as the brain was being lifted in
order to expose the two branches, it was noticed that tonic and clonic con-
vulsions were taking place in the left hand ; these disappeared under mod-
erate pressure." This would indicate that the operation took place on the
right side.
I am indebted to my obliging colleague, Prof. Biondi, who was
director of our surgical clinic, for having been enabled to study the
case of C, on whom he performed a partial resection of the left
Gassirian ganglion ; the craniectomy was done after Krause-Hart-
ley, and the patient recovered, having suffered from a transitory
aphasia, which was caused by the operation.
The patient was 66 years of age, a native of Cagliari, who had
suffered, during a period of 14 years, from facial neuralgia that had
not yielded to any treatment. The unbearable suffering decided
the patient to undergo the operation.
THE OPERATION.— I shall give Biondi's (1) description in
part. On opening the skull, the temporo-sphenoidal lobe bulged
out, making a resistant hernia ; at first, it seemed that the reduction
would be quite a difficult operation. Gradual compression was
brought to bear on the bulging mass, which lost in resistance as it
was being manipulated ; during the operation it showed imprints
of the instruments applied in the process of reduction. The two
branches of the Vth nerve were cut through and part of the gang-
lion excised. The wound was closed and one end of a scant iodo-
form dressing was left protruding from the anterior angle of the
incision. The operation lasted two hours.
1.— MOTOR, TACTILE AND OTHER PHENOMENA.—
Before entering into the details of the case, I wish to say that after
the operation patient was promptly relieved from the neuralgic
pain (Dec. 21, 1897), from which he had suffered during a period
of so many years. The dressing was taken out on the second day,
and nothing unusual was noticed about the patient. On the third
day, C. sat up in bed, was cheerful and took his meals properly.
Dec. 26, five days after the operation, Prof. Biondi found the
wound in good condition, — almost entirely closed. The areas sup-
plied by the 2d and 3d branches of the left trigeminal, however,
presented anaesthesia; externally, the cutaneous surface was in-
volved, and internally, the gums, the corresponding halves of the
lips, the palate and the left side of the tongue were affected. Pos-
teriorly and externally distribution of the anaesthesia of the 3d
branch differed from the usual ; the tactile sensibility was present
in parts of the masseteric region, on the tragus, on the most ante-
I. Biondi. Giustificano i risultati le operazioni intracraniche sul
trigemino?
TRANSITORY APHASIA.— Prof. Fasola. 227
rior part of the pavilion and the external auditory canal. The an-
aesthetic zone of the 26. branch extended over the lower lid, the nos-
tril and the upper lip. The anaesthetic zones were also marked by
analgesia. There was no trophic disturbance of the corresponding
eye or elsewhere.
The tip and anterior margin of the tongue presented a disturb-
ance of the gustatory sense.
During the following few months, the disturbances of gustatory,
tactile and pain sensibility gradually disappeared (July 11).
2.— APHASIC DISTURBANCES.— The first aphasic signs
were noticed the first day after the operation, when the patient
could not be examined. The disturbance increased gradually dur-
ing the first week, and then remained stationary until the end of the
first month. During the latter part of January and the first part of
February, considerable improvement took place, and complete re-
covery seemed to exist at about the 15th of that month, the trouble
having lasted altogether a little over two months. The patient was
examined again in December, 1898, and in the summer of 1899, but
no traces of the aphasia could be found.
When the aphasia existed, the patient, although in perfect mental
condition, and having always had a good memory, could not recall
the name of his wife, those of his children, son-in-law, familiar
persons about him, nor that of Prof. Biondi, who was his physician.
January 7 (18 days after the operation), he conversed with his
wife at length, but could not recall the names of their children
(present there, or absent). He also found difficulty in naming
things (a clock, cigar, chair, pillow, handkerchief, key, head, or the
name of the city in which he lived, etc.). Some weeks after the
operation, he could speak spontaneously without making mistakes,
but now and then he stopped suddenly, expressing on his face some
feeling of anxiety, as if he were searching for a word; this was
always a name of some person or a noun ; but when the name was
suggested to him, he seemed to be well pleased, repeating it without
difficulty and continuing his conversation. He soon became aware
of the defect of speech from which he was suffering, and tried, on
examination, to hide his difficulty, by making attempts to elude
some questions. Finally, at one time, he did not recognize familiar
names when pronounced before him. When asked whether he
knew Prof. Biondi or other familiar names, he could not remember
whose names these were. In order to be certain that he had under-
stood the question well, he was called into the office and was asked
to give the name of his physician. He could not give the name, but
said several times "the one who is in charge here, the one who
operated on me," etc. When shown a chisel, he promptly said that
228 TRANSITORY APHASIA.— Prof. Fasola.
it was a carpenter's tool, indicated for what purpose it was used,
but could not name the metal of which the chisel was made. The
window in the room was pointed at, and he was asked to say how it
was called. After some hesitation, he said that he knew exactly
what he wished to say, but that he could not find the right word,
the necessary word.
To sum up the condition, i, — during the entire course of the dis-
turbance, the patient could understand everything that was said to
him and could respond properly and without hesitation. 2, — during
the first three weeks, when the disturbance was most marked, he
had difficulty in remembering some words, while others he could
not remember on some occasions, although he did on others, ex-
cepting during examinations by the physician. 3, — during the en-
tire course of the disease, even when it was most marked, the pa-
tient could repeat perfectly well, on hearing them pronounced, the
names of people and objects which he could not remember spon-
taneously.
During the second period of the affection, when the aphasic dis-
turbance was somewhat attenuated, the patient could be made to
recall the names which he wished to use, when we insisted that he
make an effort for that purpose, or by describing the person or
object, whose name he could not recall. Thus, he was made to re-
call the names of his children, or of the nurses, by having described
to him their appearance, occupation, or the time and circumstances
when he had seen them. He was made to recall the word "key,"
after it was put into the key hole and turned inside of the lock ; an
inkstand was shown to him and he could not name it ; he called it a
dish, a bowl or a salt cellar ; but when a pen holder was put in his
hand, he promptly dipped the pen in the stand, showing thereby
that he had recognized the object and knew for what purpose it was
used ; he then gave the proper name.
At times, he substituted words, which had no bearing on the
answer. Thus, when asked what he had eaten at dinner he said
roast tobacco, instead of roast veal. On another occasion, he
wished to ask someone in the ward to hand an egg and bread to
someone in the corridor, and he said, instead, give him the chicken
and pork. He called a handkerchief a tumbler, although he was
told the right name of the object; when shown a cigar, he exam-
ined it for a long while and after he had tried anxiously to recall itl
name, he finally said that it was a bag. He also suffered from gus-
tatory anaesthesia.
3.— SYMPTOMATIC DIAGNOSIS.— The scarcity of such
cases reported does not warrant the making of a positive sympto-
matic diagnosis. In this case there were three, out of eight, symp-
TRANSITORY APHASIA.— Prof. Fasola. 229
tomatic elements to be considered first : 1, the ability to understand
spoken language; 2, the spontaneousness of speech, and 3, the
ability to repeat words pronounced for him.
There was nothing abnormal regarding the first and third points ;
the second, on the contrary, was imperfect, as the patient could not
remember the names of subjects and objects and as at times he sub-
stituted wrong words. Five more points, which are generally ex-
amined in such cases, regarding the expression of speech by read-
ing and writing, were of negative value here, as the patient could
read and write only with much difficulty (2).
Regarding these other five symptomatic elements, they were as
follows :
4.— UNDERSTANDING OF WRITTEN OR READ LAN-
GUAGE.— On examining the words Biondi, sun, bread, wine,
healthy and sick, he understood their meaning. 5. SPONTA-
NEOUS WRITING.— Asked to write his Christian name, sur-
name and the name of his country, he wrote them spontaneously
and with some facility. 6, READING ALOUD WRITTEN
LANGUAGE. — Considering his instruction, he could read and
pronounce with ease the written words shown him. 7, WRITING
UNDER DICTATION, he wrote Chiara (the name of his wife),
table, hand, etc., although with the aid of spelling the words, sylla-
ble by syllable. 8, COPYING WRITTEN LANGUAGE.— For
the reason given above, this test is not of much value; he suc-
ceeded, however, in copying some words which were not too long.
In order to confirm the value of the results of these five tests, the
patient was examined in the same manner in 1898 and 1899, over a
year after the disapearance of the aphasic disturbance, and the ob-
tained results were quite identical to those above mentioned.
It is to be regretted that no examination was made, with a view
to discovering aphasic disturbances, before the operation was per-
formed. Regarding the symptomatic form of the aphasia, it was
evident that the patient suffered from an impaired or annihilated
2. It is now generally admitted, and for good reason, that true agraphia
can take place only in subjects, who have acquired the faculty of writing
automatically; thus, he must write with a spontaneity similar to that with
which he speaks ; his written language should no more constitute a transla-
tion of spoken words, but should be a language strictly independent, special.
Therefore, we should not expect to find instances of true agraphia except in
subjects who, through long habit, have acquired the faculty of expressing
their thoughts in writing in a way similar to that in which the deaf-mutes
express their ideas with gestures, corresponding to sounds, unknown to
them. True agraphia may be said to exist only when the subject has, pre-
vious to the onset of the affection, learned to express his ideas in graphic
tracings, which correspond to sounds, and which do not occupy the atten-
tion at the moment when they are being expressed in writing.
230 TRANSITORY APHASIA.— Prof. Fasola.
transmission of the images of spoken words. As has been related
above, the psycho-motor function was perfectly normal, but the
patient could not remember some words, — proper names and some
nouns; at times, when insistence was used, he could be made to
remember words that eluded his memory at first.
Aside from this amnesic aphasia, the patient also suffered from
another form of aphasia, — paraphasia; it was mentioned above that
at times, during the course of the disease, he substituted words
which had absolutely no bearing on the word which he should have
used instead. I should formulate, then, the conditions as follows :
the patient suffered from partial amnesic aphasia of transitory
nature zvith some traces of paraphasia.
ANATOMICAL DIAGNOSIS OF THE SEAT OF LES-
ION.— From the defects found in the psychic speech in this case, it
is evident that some of the numerous speech-centres were affected ;
especially the centre presiding over the voluntary expression of
spoken language. We must, therefore, determine which of the
numerous cortical centres or their communicating tracts were af-
fected. In doing this, we must not lose sight of the primary lesion
which, to all appearances, was the starting point of the trouble. It
will be useful for our purpose to utilize some of the known
schemas, which represent the graphic explanation of the various
and complex disturbances of speech (3).
3. It is evident that such schemas should be considered in connection
with other centres than those which they represent, as the general mechan-
ism of speech is governed by various centres, — the general auditory and
visual centres, etc., which have a special localization. We should
bear in mind, however, that the value of the schematic explana-
tion is only relative, either as a representation of clinical cases,
or as a scientific demonstration. Clinical experience shows that a
strict analogy between actual cases of aphasia and schematic repre-
sentations of the same is a rare occurrence, as the clinical forms are gen-
erally accompanied by an impairment of a marked complexity of elements
which are involved under such circumstances. It is unreasonable, for in-
stance, to assert that a subcortical lesion, adjacent to the verbo-auditory
centre U (fig. I) would intercept the fibres UI exclusively, without im-
pinging on the fibres UM or UV. To this must be added the fact that a
lesion of a given centre here is generally accompanied by impairment of
tracts that connect it with other centres. Finally, it must be borne in
mind that in making up a schematic representation of the relation of an-
atomical centres, we leave out their important correlations with psychic
centres, which also enter into play as important factors, — those of sensory
perception and of memory, for instance. Furthermore, while some centres
are anatomically located, others, quite as important in function, are not
(tactile, muscular sense, etc.) ; it is not even known, whether these centres,
in man, are generalized or circumscribed. The difficulty presented by such
cases is still more evident when we admit that our knowledge of the cor-
relation of even the well localized centres is rather vague; and, finally,
TRANSITORY APHASIA.— Prof. Fasola. 231
Whether we consider Lichtheim's schema, Fig. i — or Fig. 2,
published in Charcot's Traite de Medecine, etc., in which the rep-
resentation of some of the centres approaches the actual relation on
the cerebral cortex, the following indications apply to either :
V, centre of visual verbal images (verbal blindness). Postero-
inferior left 2d parietal.
U, centre of auditory verbal images (verbal deafness). Middle
of the left 1st temporal.
M, centre of images of articulate movement (motor aphasia).
Foot of the left 3d frontal.
G, centre of graphic movements (agraphia). Foot of the left
2d frontal.
I, symbolic ideation (intelligence of speech). Frontal lobe?
A. — CENTRES. — I shall commence with the consideration of
the verbo-visual centre V, or centre of reading (graphic mnemonic
images of speech), which is located in the postero-inferior part of
the 2d left parietal, or in the so-called gyrus angularis; we may
well exclude the supposition of any lesion here, for the reason, as
has been explained, that the patient did not suffer from verbal
the most important of the centres, those of ideation, destined to synthetize
the images received by the other centres, which are said to exist as distinct
units, are not well known to us, although we locate them in the frontal
region. These considerations show the insufficiency of our knowledge of
the subject, which we even demonstrate in schematic tracings; these can
have only a certain value as guides in analytical researches, when other
methods, more potent, are wanting.
232 TRANSITORY APHASIA.— Prof. Fasola.
blindness: he could read with a facility proper to his education;
also because some time after his recovery, this condition was un-
changed.
The same may be said regarding the grapho-motor centre G
(memory of graphic movements), which is localized in the left 2d
frontal, and a lesion of which causes motor agraphia; our patient
was free from agraphia. I pass, therefore, to the consideration of
the centre of articnlo-motor images, M (Broca's centre), which is
located in the inferior part of the left 3d frontal convolution ; the
lesion of this centre may be excluded in our case, because the pres-
ence of such a lesion causes motor or ataxic aphasia; our patient's
speech was prompt, his pronunciation was perfect ; when reminded
of the words which he forgot, he pronounced them equally well
with the others.
It may happen, as recorded in the cases of Ballet and Boix
(Traite de Medecine de Charcot, Bouchard, etc, page 121), that a
very limited lesion in Broca's centre will cause a partial motor
aphasia, limited to a certain group of words, such as nouns in gen-
eral, or verbs ; but in such cases, the pronunciation of these words
is impossible, so long as the lesion lasts ; and when these words are
suggested, they cannot be repeated, because, as is known, the fac-
ulty to repeat spoken words is wanting, on account of such a lesion.
In our patient, the faculty to read loudly and to write spontane-
ously or under dictation was preserved, but it would have been
absent in case of a lesion as above suggested.
I shall finally consider the verbo -auditory centre U (auditory
mnemonic images of speech), which is located in the left 1st tem-
poral, extending perhaps to the 2d temporal ; a lesion of this cen-
tre would cause verbal deafness or sensory aphasia of Wernicke ;
our patient was free from that form of aphasia, as he always under-
stood everything that was said to him and answered every ques-
tion put to him ; besides, other indications of having been free from
verbal deafness are : his faculty to repeat spoken words, his ability
to understand written language, to read aloud and to write under
dictation. We must admit, therefore, that the centre considered
was intact.
We may suppose, nevertheless (and with good reason), that
the impairment of the centre and adjacent tracts was so slight and
circumscribed that verbal deafness did not take place, even in a
minimum degree: the verbo-auditory images, which are latent in
some way in the cellular elements, are not lost, so long as there is
no severing of the conducting fibres between the centre of speech
and the more or less diffuse centre /, which presides over the idea-
tion of speech, or the centre of symbolic ideation. In this way,
TRANSITORY APHASIA.— Prof. Fasola. 233
spoken zvords, which could reach the verbo-auditory centre of the
patient, could still excite corresponding auditory images, which, in
their turn, would be transmitted and understood in the centre of
ideation.
It is just as legitimate to suppose here that the histological or
dynamic alterations, which affected some of the cells of that centre,
were too slight in degree to interfere with the formation of audi-
tory images, more or less intense, corresponding to the sensory
stimulus of spoken words; but that they were sufficiently pro-
nounced to interfere with the process of evoking spontaneous vol-
untary expression, in some instances, without the potent aid of
sensory impressions.
Applying the above reasoning to the patient here considered, we
can clearly understand the role played by a weakened intensity of
formation of verbo-auditory images, corresponding to some nouns
and proper names; the decreased abundance of those images in
the centre of verbal ideation, on the one hand, and in Broca's cen-
tre, on the other, was conducive to an interference, during volun-
tary spontaneous speech, with the finding of the desired word, and
the latter could not be pronounced. When the interlocutor came
to his aid, however, pronouncing the words loudly, the new stimu-
lus was then strengthened by the sensory auditory impulse and
excited the weakened imagination, or, if preferred, created it tem-
porarily, so that the centre of ideation, when having all the neces-
sary elements for the purpose of its synthesis, was able to transmit
its product to the mnemo-motor centre of speech.
With the above conditions, it is clear how and why the patient
retained the faculty to repeat spoken words, to write, and to read
loudly as well as to write under dictation ; whereas these faculties
are always impaired when the lesion is somewhat marked and
extended in the audito-mnemonic centre. In all such cases, the
immediate sensory stimuli (auditory or visual) always come to aid
in reviving and re-enforcing the impaired intensity (caused by the
somatic lesion) of the old audito-mnemonic images.
It should be remarked that in cases of verbal deafness, there is
always present a certain degree of paraphasia and paragraphia ; the
first of these existed to some extent in our patient, as was men-
tioned. On comparing the degree of the aphasic and the para-
phasic disturbances of the patient, it becomes evident that both
were represented proportionately, — in correlation with the very
limited interruption between the cerebral centres.
B.— THE ASSOCIATION FIBRES.— I have made a detailed
comparative analysis of the possible lesions of the four mnemonic
centres: verbo- visual, grapho-motor, articulo-motor and verbo-
234
TRANSITORY APHASIA.— Prof. Fasola.
auditory (cortical forms). I must now consider the possible les-
ions of the association fibres, which unite those centres, and lesions
which are apt to bring about four fundamental varieties of apha-
sia: forms of conduction, or transcortical, or intercentral aphasia
of Wernicke, Lichtheim, Dejerine, and others (4).
If we recall that in our patient the disturbances of spoken and
written speech were only marked by his forgetting some nouns
and proper names, but that he could pronounce them promptly on
hearing them pronounced, we may exclude from consideration the
centripetal conducting fibres, vV and uU and the centrifugal con-
ducting fibres Gg and Mm.
We shall now consider the intercentral association fibres; we
may well exclude from analysis the tract VG, VU and VI as well
as GI ; but we must consider the circuit formed by the tracts
UIMU, which represents the reciprocal relation of the centres of
verbo-auditory images, — those of articulate movement (of Broca)
and the centre of ideation of word symbols.
In all probability, there was no lesion in the path UI ; for, as is
known, an interruption in this path leads to an impaired under-
standing of spoken and written language, which was intact in our
patient.
A lesion in the path IM, would cause a disturbance in voluntary
speech and writing, leaving intact all the other functions of speech
as well as the faculty for repeating words spoken by others ; such a
lesion may be considered as having possibly existed in our case,
but it certainly was not sufficiently marked to cause an absolute in-
terruption of the association fibres ; on the contrary, it was slight in
degree and only partial. A phasic amnesia is the term applied to
the disease characterized as above, — when a patient cannot find the
right word, but can repeat it when it is told him.
We must not forget, in connection with that hypothesis, that our
patient could write spontaneously without any trouble ; and above
all, we must bear in mind that the more or less marked symptoms
relating to the amnesia were all connected with a slight disturb-
4. I must remark here that there exists, undeniably.a partial equivalence
between a lesion of a cortical centre and that of its association fibres. It
is evident that a destruction or impairment of a certain group of cells of 2
cortical centre is expressed only by a relative equivalent of effects produced
in the corresponding association fibres, in their relation to other centres
and to the periphery; and vice versa, the interruption of a given tract of
fibres, which constitute a prolongation of a ganglionic nerve element,
would be equivalent to a destruction of the latter, if such a lesion severed
its connection with the intermediary nerve elements. In a word, the ap-
parent distinct difference between a cortical or nuclear lesion, and that of
the association fibres, has a very relative value.
TRANSITORY APHASIA.— Prof. Fasola. 235
ance, which involved some points in the speech conductors, or — the
paths in the circuit UIMU ; also, that other seats of lesion, more
directly exposed to the traumatic action, could have brought about
similar amnesic phenomena.
In this connection, I wish to speak of the path UM ; this tract
associates the verbo-auditory centre with that of Broca. An inter-
ruption in this path should bring about, pre-eminently, paraphasic
disturbances, without in any way impairing any other essential
functions of speech. Repetition of words pronounced, reading
loudly as well as writing under dictation, would not be possible
without the ability to understand language ; but voluntary speech
could yet take place along a more round-about path UIM ; hence,
there would be a delay and difficulty in the formation and the trans-
mission of the verbal images to Broca's centre ; such, indeed, are the
characteristic traits of amnesic and paraphasic disturbances.
When the path UM is affected only partially, then the patient
cannot find the right words only in some cases: he can speak cur-
rently, but stops when he has to name some given objects ; then, he
either does not succeed in finding the word or else, substitutes a
wrong word; if the word is suggested to him, he repeats it and may
remember it during a more or less long period of time ; it is known,
as has been remarked, that the amnesic phenomena, and paraphasia
which generally accompanies them, when there exists some lesion
in the circuit UIMU, generally have reference to proper names and
nouns.
It is evident that, as seen from the summary description, the dis-
turbances must be due to a partial lesion of the path UM ; such cases
have been studied by numerous authors, and correspond exactly to
ours.
Summing up our patient's case : the points affected in the circuit
UIMI which best explain the disturbances are: the audito-verbal
centre U (middle of the left ist temporal), in a manner explained
above, and, above all, the path UM, associating that centre with the
one of articulo-motor images of Broca (foot of the left 3d frontal) ;
Wernicke considers the island of Reil as the seat of articulo-motor
speech, at least to a great extent.
NATURE AND CAUSE OF THE LESION.— We should ex-
clude from consideration the question of infection or inflammation
for two reasons: the aphasic disturbance appeared immediately
after the operation, and there were no symptoms of infection at any
time after the operation. With the absence of tangible causes, we
are forced to resort to hypotheses. One of the first points to con-
sider in this connection is the inevitable irritation and somewhat
rough handling of the protruded part of the brain during the oper-
236 TRANSITORY APHASIA.— Prof. Fasola.
ation, which lasted two hours. It is quite certain that the irrita-
tion caused by the exposure to the air, the contact with the instru-
ments, the antiseptic solutions and the repeated and marked appli-
cations of the tampon must have had some action on the delicate
membranes of the brain as well as on the brain tissue itself (5).
Above all causes, however, we must look toward the induced
disturbances of circulation ; these were, most probably, prominently
connected with the onset of the functional defects. A possible
extra-dural hemorrhage might also be considered ; but this suppo-
sition is hardly justifiable, as the end of the dressing that was left
outside the wound would have indicated to some extent that an
accident of that kind had taken place.
Undoubtedly, the pressure that was used in returning the cere-
bral hernia into the skull, in the beginning of the operation, was the
cause of the immediate disturbances of the speech; the temporal
lobe sustained this pressure from below upwards and from outward
inwards ; the postero-inferior part of the left frontal lobe suffered
at the same time from that pressure. The reduction of the cere-
bral hernia was performed most skilfully and with as much care as
possible, but the process was tedious and it was noticed that the
instruments left imprints on the tissue as the act of reduction was in
progress. It is evident that no small amount of pressure had to be
exerted ; the convolutions which suffered from this accident were :
the three temporal, externally, the lower parts of the Rolandic, the
third frontal and the whole of the insula which made its way from
between the Rolandic folds; the anaemia caused in these tissues
through compression of the Sylvian artery should be taken into
account.
Repeated experiments as well as clinical cases have shown that
nerve cells subjected to anaemia through compression promptly
5. I can confirm the truth of this supposition by some results obtained
by me in experiments on dogs and cats; I purposely opened their skulls,
with, much care, exposing the lateral part of the brain to view, without in-
juring the dura; the brains remained exposed to the air a little less than
an hour ; the instruments and dressing were also held in position and, be-
sides, slight digital pressure was applied from time to time; an examina-
tion was made 24 hours later, and the dura was found injected, the cerebral
tissue slightly cedematous on the surface and there were scattered puncti-
form hemorrhages.
Prof. Tito Carbone wrote to me about a man, who was operated on for
resection of the Gasserian ganglion ; the same method was used as in our
case, but the patient died a few days after the 'operation, from pneumonia.
At the autopsy, it was found that the cerebral area, where the traumatism
was inflicted, was softened, slightly cedematous, and traces of numerous
punctiform hemorrhages were scattered. This form of lesion is quite
identical with the one which I obtained in animals.
TRANSITORY APHASIA.— Prof. Fasola. 237
manifest visible morphological alterations (6) ; it is natural to sup-
pose that the pressure caused by the application of the instruments,
which left their imprints on the tissues, should have had a marked
effect on the nutritional function of those parts as well as on the
distant neurones and the association fibres.
Capillary hemorrhages and capillary serous exudations might
also be considered here.
In conclusion I wish to say that anatomical lesion, induced by
marked and prolonged pressure of the left temporal lobe, was, in all
probability, the immediate cause of the aphasic disturbance. As
the main pressure was brought to bear on the middle third of the
external and inferior surface of the temporal lobe, we may safely
say that the localization of the lesions was as follows :
i. In the cortical and sub-cortical substances of the temporal
lobe, especially in the middle third of the ist and 2d convolutions,
which were most exposed to the handling.
2. In the island of Reil.
It is evident that the compression of the Sylvian artery and its
branches may have caused some lesions in distant parts; one of
such parts of interest to us is the 3d frontal, in its cortical and sub-
cortical layers.
We remarked on a previous page that in our case the points of
interest in the circuit UIMU were the verbo-auditory centre U (the
middle part of the left ist temporal) and particularly the path UM,
which connects this centre with that of Broca, which is situated in
the island of Reil; we find, then, that our conclusions coincide,
when arrived at from two different standpoints: 1, the considera-
tion of functional activity, or 2, the correlative analysis of anatomi-
cal lesions ; our reasoning is correct even to the point of including
the possibility of the involvement of Broca' s centre ; or, still better,
a slight disturbance (through the compression of the anterior
branches of the Sylvian artery) in the connecting fibres between
this centre and that of symbolic ideation.
6. Marked cellular alterations were found in the spinal cord after liga-
tion of blood vessels for a period of 30 minutes.
STUDIES OF MORBID OBSESSIONS.
(From the Moscow Psychiatric Clinic).
By
DR. SERGE SOUKHANOFF,
Privat-Docent, University of Moscow,
and
DR. PIERRE GANNOUTCHKINE.
The clinical knowledge of morbid obessions is as yet very lim-
ited ; we shall analyze here the obessions as we observed them in
patients at the Moscow Psychiatric Clinic. We have studied for
this analysis 12 indoor and 85 outdoor patients afflicted with obes-
sions. (1) These cases presented obessions as individual affec-
tions, not as accidental symptoms of some other disease ; we make
this statement purposely, as we consider morbid obessions indi-
vidual psycho-neuroses, in no way differing from the individuality
of epilepsy or hysteria. In our cases we make no distinct group
of the cases which suffered from obessional fear and imagination
(phobias) as Freud does (2) as he admits that the varieties which
he differentiates may sometimes come under one heading. From
a practical standpoint, such a distinction is not only wrong but even
impossible.
THE AVERAGE NUMBER OF THE PATIENTS AND
THE DIVISION ACCORDING TO THEIR SEX.— Of the 97
patients, there were 76 men and 21 women. The ratio showing the
relative number of men to women who suffered from the affection
here considered is as 3.62:1 ; this proportion is undoubtedly high
when compared with the ratio of men to women who suffer from
general psychiatric affections ; statistical data of the Moscow Psy-
chiatric Clinic, covering a period of time to the extent of 12 years,
fix the latter ratio as being 1.75 :i. This fact is quite interesting,
as women are the more numerous sufferers from another disease —
1. The histories of the out-door cases were studied by both authors, and
the clinical histories were prepared by Dr. S. Soukhanoff.
2. Revue Neurologique, No. 2, 1895.
OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
239
hysteria. Our figures relating to the question in point seem to dif-
fer from those furnished by Drs. Pitres and Regis, who stated at
the Xllth International Congress of Medicine, that they had found
the ration between men and women who suffered from obsessions
to be 96:154.
OCCUPATION. — Division according to occupation furnishes
the following figures : church employees, 8 ; tradesmen, 1 1 ; clerks,
11 ; men who work at home, 14; housewives of tradesmen and fac-
" tory hands, 17; persons employed in the intellectual professions,
29 ; no information in 7 cases.
We do not undertake to make any positive conclusions regarding
the influence of the various professions on the development of mor-
bid obessions ; nevertheless, it is strikingly noticeable that the affec-
tion seems to attack, preferably, persons engaged in pursuits re-
quiring intellectual concentration ; among our male patients we did
not find a single farmer, and in the common number of men and
women we did not find a single one who entered under the heading
"Domestic Service."
HEREDITY. — The influence of heredity has become a gener-
ally accepted factor in the production of psychic disturbances.
Nevertheless, it seems to us that this influence should always be
considered from at least two relative standpoints: 1. the relative
frequency of heredity in connection with given forms of psychiatric
manifestations ; 2, the degree of hereditary influence in connection
with the form of the disease. We shall illustrate these points with
clinical demonstrations. Of 94 of our cases, 87 had histories of
psychiatric heredity, and 7 of the patients were free from the same ;
expressed in concrete figures, the above given ratio shows that
hereditary influence existed in 92 per cent, of the cases. As for the
determination of the degree of hereditary influence, which is not an
easy matter to analyze, we resorted to a simple guide, as will be
seen below, in the detailed analysis in this respect of the 94 cases.
Seven cases disclaimed the existence of any psychiatric disease
in their families ;
Thirty-eight patients claimed to have from one to two relatives
who were, or had been, afflicted with mental diseases ;
Thirty patients claimed similarly from three to five relatives, and
nineteen cases similarly claimed from six to ten relatives.
We assume that cases whose histories revealed that there were
more than three psychopathic members in their respective families,
may be considered as suffering from marked hereditary influence ;
as is seen from the figures cited above, more than half of our cases
may thus be said to suffer from marked hereditary influence.
When considering the question of heredity we took into account
240 OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
alcoholism, nervous and psychopathic diseases of the members of
the family (father, mother, and the nearest relatives — brothers,
sisters, grandparents, uncles and aunts).
We made a further analysis of the histories with a view to defin-
ing the degree of hereditary influence, considering parental hered-
ity only ; we found that 88 of our cases presented heredity as fol-
lows : 7 cases had no history of heredity ; 32 had morbid heredity on
one side of the family and 49 cases had morbid heredity on the ma-
ternal as well as on the paternal side. We conclude, therefore, that*
patients subject to morbid obessions bear the brunt of a heavy mor-
bid heredity. Besides, a question presented itself for our consider-
ation regarding the homogeneousness of the diseases of the parents
and of their respective offspring. The figures which we obtained
in this investigation show that 30 cases out of 94, or almost one-
third, gave histories of homologous affections in their parents or
relatives. Incidentally, we found out that the disease was most
frequently transmitted from the mother to the son and least fre-
quently, from the father to the daughter. Instances of frequent
transmission of the disease from the mother to the daughter, and
the father to the son were not as marked as was the reverse mode
of transmission mentioned above. The following two cases are
examples of inheritance of homologous diseases.
Case I. OBSESSIONAL IDEAS OF MOTHER AND
DAUGHTER. — E. A. S., 33 years of age, came to Psychiatric
Clinic Oct. 11, 1896. One sister, by another mother, suffered from
folie du doute and died of pulmonary tuberculosis ; another sister
was an alcoholist and has suffered from some form of mental dis-
ease. The patient's occupation is her own housework. She states
that the beginning of the disease dates seven years back. She
noticed then that she was highly nervous and exacting ; on finding
some spot on her dress she felt considerably annoyed and so upset
by the incident that she could not dress herself. Her punctilious-
ness was carried to extremes ; she washed her hands at repeated
intervals, even when there seemed to be no apparent reason for so
doing ; this propensity, however, she first manifested when she was
18 years of age. She feared that the dyes of materials that she
touched would stain her hands, then be conveyed into her mouth
and that in consequence of this her teeth would fall out. On touch-
ing any colored material she experienced some special sensation.
Her obessional fear of color became so marked that the mere pass-
ing through the streets and looking at the paint of the houses was
a torture to her. She suffered, besides, from various other obes-
sional ideas : hearing of sounds, seeing of images and certain sim-
ple ideas enervated and annoyed her. A few years ago, while roll-
OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine. 241
ing the house linen, she suddenly imagined that she had used a bot-
tle instead of the rolling-pin. She knew that she was wrong ; she
could see her rolling-pin and she knew that she had not left the
room and gone out to take the bottle, but she persisted in torment-
ing herself with this thought ; she could not be reassured, although
she could see that she was mistaken and could use her senses of
touch, etc., which were perfectly normal. From that time on, she
became a victim of doubts ; no matter what she did, she inquired of
everyone near her whether she had not made some mistake, etc.
She then began to have fears that her eyes would be injured by
broken glass; when looking at a pane of glass she feared that it
would break and that some of the pieces of glass would penetrate
into her eyes. She was so intensely beset with this idea that she
imagined herself hearing continually a sound produced by breaking
glass ; this sound was so vivid to her that she called it "auditory
hallucinations." At times, she was under spells of intense fear that
she would be compelled to take medicine in a glass. So intense
was this obsession that the mere thought of a physician's prescrip-
tion immediately brought on the thought of the fatal glass. If she
came across the word "medicine" in any book, she feared to touch
that book afterwards, because it suggested to her the idea of glass.
She also suffered from a number of other obsessional ideas.
On examination, the patient was found to be in poor health, suf-
fering from endometritis and frequent hysterical spells. She says
that she wakes up every morning with a feeling of marked lassi-
tude, because she fears the act of dressing ; while putting on her
clothes, she has an obsessional desire to spill some kerosene oil, to
break a pane of glass, etc. She dresses very slowly, as she is hin-
dered in the progress of the act by various fears ; she fears to comb
her hair, is tormented with doubt as to whether the comb is in her
hands, etc. When taking a cake of soap into her hands, she doubts
that the cake is really there. At meals she fears to drink milk from
a glass ; she pours it out into a plate and sips the milk with a spoon.
She is quite depressed mentally and often thinks of committing sui-
cide, as she finds many hindrances in the performance of her daily
work ; she is afraid to use the sewing machine because the needle
might break and some splinter of the steel get into her eyes ; she is
afraid to light a lamp or even to touch one. During the last one
and a half years she has been busy writing up her own history ; this
occupation seems to quiet her to some extent.
The patient's daughter, a school girl, A. S., 14 years of age, is
also subject to obsessional ideas and applied for treatment of this
affection, Oct. 13, 1896. The mother states that the child showed
the first manifestations of the disease when she was six years of age.
242 OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
She was frightened when anyone touched her dresses or books ; she
suffered from great fear that she would lose her earrings ; if the
ears were covered by the head dress, she promptly disengaged
them, fearing that otherwise the earrings would slip out from the
ears ; one and a half years ago she failed to pass her examinations,
and came home, unable to speak ; she lost her voice suddenly, and
has been speaking in a whisper since that time. A laryngeal exami-
nation of the throat made by our specialist in this department
showed that there existed a granular laryngitis, a vegetative aden-
itis, a swelling of the false vocal cords and hyperemia of the entire
throat. The cords are normal but do not contract properly during
speech. She began to menstruate one year ago, but the flow is not
regular in appearance. She still fears the possibility of her losing
her earrings ; she is considerably depressed mentally, and does not
converse readily ; she may have some other obsessions, but the one
observed is her constant fear of looking untidy ; she continually
uses the comb trying to keep her hair tidy.
Case II. OBSESSIONAL IDEAS IN THE MOTHER AND
SON. — B. S. T., 32 years of age, housewife. Her sister is subject
to some mental disturbance and suffers from obsessional ideas ; her
father is known as being "odd" of conduct. The patient menstru-
ated for the first time when she was 15 years of age ; but some time
before the onset of puberty she learned from her girl friends that
the pelvic organs of women undergo some changes after marriage ;
this news impressed her considerably, and she soon became a vic-
tim of an obsessional fear that such changes would take place in her
organs. Before she was married, her monthly flow was delayed on
one occasion ; she became greatly alarmed about the incident and
feared that she was pregnant, although she knew very well that her
fears were unfounded. Her obsessional ideas became more numer-
ous after her marriage; after the first few days of married life, she
began to suffer from an obsessional sensation of shame before her
friends; she worried herself about the thoughts that her friends
entertained in regard to her, and her health began to fail. This
sense of unfounded shame caused her later some other and more
marked inconveniences. Her first child was born some time ahead
of that calculated by her when her confinement should take place ;
she consequently became beset with fear that her child was consid-
ered as being illegitimately born. When pregnant with her second
child, she suffered from a fear that some man would force his way
into her rooms and would dishonor her. This fear persisted during
the entire period of lactation. Five years ago, after the birth of her
third child, she began to entertain some doubts regarding the legit-
imacy of her marriage, as she imagined that she was related to her
OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine. 243
husband; she therefore, decided to lead a single life; besides, she
feared that she was filthy, that her clothes which she wore while
leading a married life, were filthy. The obsessions seem to pivot
about erotic ideas ; she fears that her clothes, the table linen, the
floor and other surrounding objects are soiled with sexual secre-
tions ; yet, her sexual appetite is altogether nil, and she has never
had any excitement of that nature. Some of the other obsessional
ideas are not less odd in character; when she bites off a piece of
bread, she is worried with the thought that the bread is "divinity."
She benefited greatly by a prolonged stay at the Clinic, and on
the date of her discharge she seemed very much improved. While
at her home, she sustained a severe moral shock, however, and her
disease again became marked ; she re-entered the Clinic five months
later.
THE SON OF THIS PATIENT.— The son of this patient 14
years of age, entered the Clinic in 1897, and asked to be treated
for obsessions, which consisted essentially of erotic ideas and folie
du doute.
Among our cases, we had two brothers and two twin brothers.
We cite these cases below.
Case III. — S. N. B., brother of B., 18 years of age, came to the
Clinic March 22, 1895. His mother had an attack of some mental
disease, but recovered from it. The patient states that during the
four years preceding his admission to the Clinic he began to suffer
from a sensation of "cloudiness" in his brain. Lately, he became
subject to annoyances from everything about him; he also mani-
fested symptoms of folie du doute ; when passing some object, he
imagined that he had passed it in a wrong manner, returned to the
starting point and passed the same object again. He also imagined
that unless he would do certain insignificant acts some evil would
befall him. He said, in a written account of his own disease : "I
often have morbid ideas against which I have to struggle ; I am,
under those circumstances, like a slave, commanded by those ideas,
although I am quite aware that this reasoning is absurd ; it seems
impossible for me to act independently and against them." He
suffered from an obsessional sense of fear that he would be buried
alive, that he was not clean, etc.
Case IV. — A. N. B., brother of the above patient, 15 years of age,
came to the Clinic March 28, 1895 \ n^e his brother, he also suf-
fered from obsessional ideas. In 1894 he began a course of business
education. This included the study of penmanship, and he devoted
a good deal of thought to the prospect of his accomplishing the un-
dertaking. At first he only had obsessional mental representations
of the appearances of his writing as a whole; but later on, these
244
OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
became more and more circumscribed, — he tried to see mentally
the appearance of sentences, then of phrases, and, finally, he be-
came beset with the thought of the looks of individual letters ; he
feared that the letters looked crooked, "although any normal mind
would find no fault with the configuration," he says. His work was
considerably hindered by these obsessions, although at time he suc-
ceeded in quieting himself. As a rule, however the worry thus
occasioned causes him intense headaches and dizziness. For this
reason, he conceived a dislike to handwriting and it became an
effort to write. He even disliked the sight of the letters of the
alphabet, and the letter "i" inspired him with a feeling of antipathy
more than did the others, if that letter was not written as perfectly
as he thought it should have been. He, therefore, devoted a great
deal of time to the thought of perfecting himself in the art of trac-
ing that letter masterfully. He also suffered from various doubts,
fearing that what he had done was wrongly done ; he also suffered
from erotic ideas, etc.
Case V.—A CASE OF OBSESSIONS IN ONE OF TWO
TWIN BROTHERS.— G. A. M., 13 years of age, a school boy,
entered the Clinic Nov. 17, 1901. The father was an unbalanced
man and it is supposed that he had committed suicide. The mother
suffers from obsessions of doubt and is very impressionable. A
maternal aunt and uncle had had attacks of some form of mental
diseases. A paternal aunt committed suicide. One brother died of
meningitis and another of tuberculosis. A sister, who suffered
from tuberculosis, committed suicide. The patient is one of twins ;
the other twin brother seems to be quite normal in every way. Both
were born at full term. Immediately after birth, it was noticed that
our patient's head was considerably larger in size than that of the
other twin. Our patient began to walk during his second year,
whereas the other twin began to walk much earlier. The teething
also took place earlier in the other twin than it did in the patient.
Our patient was more apathetic and less intelligent than was his
brother when they were growing up, although the other twin
was the weaker physically. Outwardly, there is also ab-
sent any resemblance between them, although there was
a resemblance between each of the other children in the
family. At school, the patient was not proficient and learned
his lessons with some difficulty. When nine years of age, while he
was playing with some children, he fell and hit his head against a
stone ; no outward consequences were observed, but he had a spell
of vomiting which was followed by unconsciousness ; on recovering
his senses, he was restless, and shrieked and then became speech-
less for a certain length of time. From that time on, he seemed
OBSESSIONS.— Drs. Soukhanoff and Gannoutchkine. 245
more nervous ; he became fearful and whining and avoided his com-
rades; he applied himself more assiduously to his studies and rap-
idly caught up with his classmates ; he also became markedly vain.
During the year preceding his admission to the Clinic, he began to
suffer from an obsessional fear of being mocked. In the Fall of
1901 he had obsessional crying and shrieking spells, which gener-
ally lasted some 15 minutes. He explained that these spells fol-
lowed some bad thoughts, which forced themselves on his mind,
and that he feared divine punishment for having such bad thoughts.
As these spells increased in frequency of appearance, the patient
lost in body-weight, became melancholy, and slept badly and suf-
fered from erotic ideas, of which he was ashamed to give any ac-
count. However, he told his mother that he was pursued by a
mental representation of the figure of a naked man, exposing his
genital organs to God, and that at one time he was beset with a
mental representation of figures of a whole row of naked men.
The child begged to be treated for his disease, as he feared that he
would otherwise lose his mind. He feared divine punishment for
having these ideas and he soon began to suffer from obsessional
fear of graves ; he had before his mind's eye a persistent representa-
tion of graves. He is most reticent when questioned about his,
erotic obsessions, but after some insistence on our part we suc-
ceeded in obtaining a statement from him ; he said that in the mental
representations of these figures of naked men their genital organs
were more distinct in outline than were any of the other parts of
their bodies. He suffers, besides, from folie du doute.
A point of interest in this case is the fact that the twin brother of
our patient, whom he does not resemble in either the physical or the'
mental traits, is entirely free from obsessional ideas, whereas, it is
a well known fact that twin brothers, who do resemble each other,
generally both suffer from the same form of mental affection, when
such an affection takes place ; there are records, however, of cases
where one twin has succumbed to psychic disease, while the other
remained free from a similar disturbance. Cullere reported such an
example in the Archives de Neurologie, Feb., 1901. Still, it were
premature to state now that our patient's twin brother will always
remain free from obsessional ideas; at times, the development of
psychic diseases in twins is not synchonous. If, however, the
healthy twin should never, during his life, manifest any morbid
obsessions, the fact would only demonstrate the possibility of dis-
tinctly different psychic organization of twin children.
CHARACTERISTIC TRAITS OF SUBJECTS SUFFER-
ING FROM MORBID OBSESSIONS.— Subjects suffering
from morbid obsessions all have some traits in common. They
246 OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
have uneasiness of mind, lack of determination and doubts, which
generally begin during childhood and last throughout their life-
times. The above named uneasiness constitutes the basis of ob-
sessions, as it serves as a source of abnormal moods ; these moods
are seen in the manifestations of oddness of conduct, manners, shy-
ness, rumination, inability to get along with people, tendency
towards isolation, etc. As a rule, the indecision and doubts arise
from heightened impressiveness and often from irritability. These
subjects often resort to auto-analysis of their conditions and are
therefore often preoccupied with thought. These patients sel-
dom show any roughness or cruelty towards living things ; if they
are egotistical in their relation towards those near them, the fact
is due rather to their lack of appreciation of their own oddness of
conduct towards those people. On the other hand, those subject
to obsessional ideas may suffer from remorse of causing trouble to
their relatives or friends. Their obsessions are generally in con-
tradiction to their moral dictates. A large number of those suf-
fering from obsessions are also subject to hypochondriacal ideas.
These subjects are also fearful of becoming insane.
THE ONSET OF DISEASE.— We find that the majority of
cases manifest their disease before the age of 20 years ; this was
the case in 77 of our cases ; after 20 years of age, the onset took
place in 1 1 cases ; we have no definite indications on this question
in 9 cases. We may conclude, therefore, that the onset of ob-
sessional ideas takes place at an early date in life. There is reason
to believe that the uate of onset is far earlier than the stated figures
indicate it to be. It is very difficult to obtain any correct state-
ments regarding this question, if the patient is of middle age when
he presents himself for treatment. As a rule, the development of
the disease is very gradual ; in 89 of our cases, this fact was veri-
fied; in some cases, however, we obtained histories of sudden on-
sets ; of such cases we find 7 ; in one 1 f these, a man, the disease set
in after an unfavorable change of surroundings ; in 4 cases, women,
moral shocks were the causes, and in 2 cases, — after childbirth ; in
1 case no information was obtained.
THE COURSE OF THE DISEASE.— The course of this dis-
ease is very irregular : the obsessions vary in intensity according to
circumstances. We shall consider the conditions most conducive
to the development of obsessions of an intense degree. In women,
the menstrual periods, gestation, childbirth and lactation seem to
favor an aggravation of the disease. The period of puberty or
that of involution are favorable moments for the onset of this
affection. Various moral and physical disturbances may favor
that onset ; in some cases, however, there seems to exist no assign-
OBSESSIONS.— Drs. Soukhanoff and Gannoutchkine. 247
able cause. The influence of genesic evolution and involution is
so marked that we do not hesitate to cite some illustrative examples.
Case VI. — F. B. S., 64 years of age, came to the Clinic Oct. 18,
1896. His mother is very nervous. Since he was 12 years of
age, the patient has been subject to various obsessional ideas.
When saying his prayers he generally had some erotic obsessions ;
he has always been noted for his doubts ; there seemed to have
been a decrease in the intensity of the disease, however, as he
grew older, and he felt quite free from the obsessions when he was
15 years of age. He had no trouble of this nature until 8 months
previous to his admission to the Clinic, when he again became sub-
ject to a large number of obsessional ideas. The present obses-
sions were of an erotic nature, and he lost much sleep from worry
over his condition. He even attempted suicide on account of the
unrest caused him by these thoughts. He was fearful that he
would commit some forbidden and unlawful act. The sight of a
knife impresses him considerably; on seeing the sharp instru-
ment, he pushes it away ; on the sight of the object he becomes up-
set in his mind, fearing he may commit some evil deed; he rec-
ognizes the fact that he is wrong in entertaining these fears, but he
cannot change his condition by reasoning.
In one case, obsessions set in during an attack of cerebral syph-
ilis, but disappeared, when specific treatment lessened the severity
of the organic affection. This case is cited below.
Case VII. — O. A. A., 24 years of age, draughtsman. His father
and mother are both nervous persons. Some six years before he
came to the Clinic, he suffered from an acute urethritis, and one
year ago became infected with syphilis. He says that when a
child he suffered from various obsessional ideas : erotic, religious
and other; he had obsessional fears that he would kill somebody,
that he ran the risk of some danger unless he did certain
things, which had no relation to his surrounding circumstances;
for instance, he imagined that if he should fail to say a certain
prayer, he would kill somebody ; if he should fail to put his finger
to the lower lip he would speak imperfectly, etc. The intensity
of the obsessions varied with his physical condition, humor or
even the weather. He came to the Clinic for consultation, at
various times between 1897 and 1900. In 1898, he presented him-
self for treatment for cerebral syphilis (diplopia, hemiparesis, para-
phasia, etc.), which yielded to specific treatment. When the
cerebral affection was at its height, the patient manifested ob-
sessional ideas of marked intensity, which were accompanied by
spells of weeping.
MOTOR DISTURBANCES AND CHANGES OF CON-
248 OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
SCIOUSNESS. — S. Freud {Revue Neurologique, No. 2, 1897)
gave his opinion that there was an intimate relation between hys-
terical and obsessional manifestations. He considers angstneurose
(which we do not differentiate from obsessional fear) as an equiva-
lent of fear caused by worry and uneasiness (Neur. Centralb., No.
2, 1895) ; he points out that I, various forms of obsessional spasms
cannot be differentiated from hysterical manifestations of a simi-
lar nature; 2, various forms of syncopy cannot be differentiated
either. We investigated this question, therefore, with a view to
verifying the value of his statements. An examination of 97 cases
gave us the following results: 1 was subject to epileptiform at-
tacks; 3 suffered from dizziness; 5 (all women) had hysteriform
attacks ; 8 were subject to spells of syncopy ; in two of these cases,
the onset of the syncopal spells were accompanied by obsessional
ideas of fear; this fact confirms the opinion of Seglas {Legons
Cliniques sur les Maladies Mentales, 1895) that spells of syncopy
of obsessional nature are peculiar in the fact that the con-
sciousness remains clear before and after the attack takes place,
but that there is loss of consciousness during the attack. The fact
that obsessional ideas are in some way connected with such spells
of syncopy should serve as a guide to finding the true clinical sig-
nificance of these phenomena ; the spells of syncopy thus related to
the obsessional ideas should not be looked on as simple accom-
paniments of accidental nature, but, on the contrary, as manifesta-
tions intimately related to the phenomena of the obsessions them-
selves. Jahmaerker's case (Berl. Klin. Woch., No. 42, 1901)
should be considered from the standpoint which we have just indi-
cated.
SEXUAL ANOMALIES.— An examination of the sexual
anomalies of our cases among the men gave the following re-
sults : In 1 case there existed an anomaly of that sense ; in 4 cases
there was exaggerated excitability; in 42 cases masturbation was
noted and in 28 cases no anomalies could be found, or; rather, no
mention was made of any anomalies ; no information could be ob-
tained in 22 cases. It is evident, from these figures, that obsessional
ideas are frequently accompanied by sexual anomalies, — almost
in two-thirds of the cases. We do not think that these anom-
alies are not dependent on the specific causes of obsessions,
given by Freud; whatever the genesis of these anomalies may be
in connection with the obsessional ideas, we are of opinion that
they are symptoms of the disease here considered, rather than that
they are its causes.
THE RELATION OF OBSESSIONS TO DEMENTIA
PRECOX. — In the study of our cases, we gave particular at-
OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine. 249
tention to the question of the relation of obsessions to dementia
praecox. Although the cases that ended in precocious dementia
were not numerous, there was, nevertheless, a sufficient number
of such cases to attract our attention. We had only five such sub-
jects, two of whom we could keep track of. We did not group
these cases with the others. We do not wish to draw here any
definite conclusions regarding the complexus of such clinical symp-
tomatology, but shall simply relate such clinical manifestations as
were observed by us ; careful study of these complex diseases may
help to elucidate the question in the future.
Case VIII. — S. K. E., 22 years of age, man, single, clerk by oc-
cupation. His mother is an illegitimate child and is feeble minded.
The patient had a mild attack of small-pox, when a child. He
was not bright at public school. His habits were regular and he
did not indulge in spirituous drinks. When 20 years of age, he
first became subject to obsessions : one of his friends had told him
that he would be benefited if he were married; this idea made a
profound impression on the patient, and from that day, during a
period of three months, he practiced, against his will, the imagin-
ary act of copulation. This obsession was followed by a series of
others, which have persisted since that time. He was a victim
of obsessional mental representations of graphic images of certain
word ; for instance, the words sky, wind, name, to look, hear, etc. ;
at times, the words were expressive of obscene meanings. He
was worried also by the difficulty in explaining the meaning of
God and that of man's existence; this inability caused him pro-
found anxiety. Later, he found that he could not look straight
at objects, and he imagined that he had some current in the left
side of his head; he also felt impelled to look at objects from the
left side. In order to rid himself of this trouble, he thought
that if he had in his mind a representation of a figure resembling
the Russian letter "g" his trouble would be remedied. This fig-
ure then became a new object of obsessional thought, as he could
not rid himself of the mental image of this letter. He was
treated at the Clinic during 1889- 1890. During the last six
months of his treatment, a new series of obsessions developed;
he felt impelled to pass his left hand through his hair, turn his
head towards the right side, tap with his fingers on the table, etc.
While engaged in a conversation, he suddenly stops, performs the
series of acts as described, then resumes the conversation at the
point where he has left it off. At times, he imagines that the
surrounding objects are in motion, that the left side of his face
moves towards the left side, while the right side moves towards
the right, that his eyes are covered with skin, that his legs are
250 OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
longer than usual, that he is dead and that somebody imperson-
ates him. He is quite depressed mentally and often thinks of
committing suicide. He also shows some stereotypias ; he as-
sumes positions expressive of strenuousness of mind; besides,
every noise, even that caused by the rolling of a ball on the floor,
serves as a starting point for the appearance of a whole series
of obsessional ideas. At times, he has spells of uncontrollable
laughter. He is unfitted for any occupation, not even for simple
reading or carrying on a simple conversation; the latter fatigues
him quickly. He also has chills, now and then.
We received information after his discharge that he had ended
by falling into a condition of dementia praecox.
Case IX. — Cr. N. B., 22 years of age, single, clerk, was treated
at the Clinic during a period of six months, in 1887- 1888. His
father was an alcoholist, suffered from progressive general paraly-
sis during a period of seven years and died of an apoplectic at-
tack ; a brother, who was also an alcoholist, suffered from melan-
cholia and died of apoplexy; the mother and sister are suffering
from headaches ; a paternal aunt is insane. The patient had deli-
cate health when a child and began to speak when he was three
years of age. He was of normal mental condition, and was
even considered brighter than is usual, until the age of 7 years.
At that age he sustained a fall and was unconscious for
some time, and there was some hemorrhage from the mouth.
From that date, the mental development of the patient did not
progress and he was unsuccessful at school. He had typhoid
fever at the age of 13 years. At 15 years of age, he left school
and engaged himself as clerk; this occupation kept him at work
from 8 o'clock is the morning until 7 in the evening, and his
health began to fail under the strain. During the six years fol-
lowing, his mental faculties seemed to become dulled and
he became worried by obsessions. He tried to relieve his
melancholic condition by using alcoholic drinks to a considerable
extent. His disease progressed gradually, and he was finally
discharged by his employers as an unfit subject. He suffered at
that time with marked obsessional doubts : on leaving his seat, he
looked about, trying to see whether he had not lost something;
at times, he stopped in one place, immovable, absorbed in
thought, during a period of some 30 minutes. When he had
to leave the house he remained immovable for some length of
time, before deciding to go out on the street. Two months
previous to his admission to the Clinic, he stopped going out of
the house and complained that there was something wrong in his
head. He began to collect all sorts of refuse, although he knew
OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
251
very well that the articles were useless ; he had no power to resist
making these collections, he said. On admission to the Clinic, he
spoke rationally, recognized his pitiful condition of being governed
by obsessions, but said that he could not help that, as he could
.not exercise his will power. While under treatment, he was
considerably worried by doubts: on seeing any object he imme-
diately became worried by the question as to its usefulness and
could not calm himself until the matter was decided to his satis-
faction ; on hearing the slightest noise, he felt impelled to find out
the cause of the same; on going to bed, he gets up some ten
times, trying to convince himself that the lights are put out prop-
erly. The obsessions are very much more pronounced when he
is alone; he is then depressed, slow of action if he is doing any-
thing; in the morning, when dressing, he looks as if under some
spell, — plunged in thought and melancholia; at intervals, he ex-
amines most carefully and very slowly every article of his dress,
putting in about two hours in this act. Before leaving his room
he meditates, as if not resolved to move ahead; he goes towards
the door, comes back, and repeats the action several times, until
finally he runs out of the room in a hurry. Towards evening he
seems more master of himself, however. He is totally incapable
of any mental exercise. His intellect showed signs of enfeeble-
ment, and finally he developed hallucinations of hearing, sight and
smell ; he also suffered from unsystematized delusional ideas.
Case X. — D. A. A., 19 years of age, a peasant girl, house-
worker, was treated at various times at the Clinic, during the
year 1900. Her father is an alcoholist. During childhood, the
patient had small-pox, measles and some other fever. When
ten years old, she sustained some fright and remained melancholic
during the following month. When 11 years old, she had a
transitory attack of hallucinations of hearing, of a musical nature :
she imagined that she heard some one singing. Five years before
her admission to the Clinic, she began to suffer from obsessions,
which have persisted to this day. The onset of the obsession is
marked by a feeling of depression and precordial anxiety, then
she begins to cross herself indefinitely and cannot stop this act of
her free will. At church, she is prevented from following the serv-
ice, because all her attention is taken up with the unrestrainable
act of crossing herself. Besides, she suffers from various doubts
and fears ; she is afraid to look into a barrel filled with water, she
fears the sight of water itself, she is afraid of being filthy and
washes her hands an immoderate number of times through the
course of the day. When performing some simple act, she
doubts whether she is doing the act rightly. At times, she has
252 OBSESSIONS. — Drs. Soukhanoff and Gannoutchkine.
hallucinations of sight and hearing, — she imagines herself to be
the object of observation, that she is being scolded and pur-
sued. She also has spells of anger and irritation. She has be-
come enfeebled mentally, talks incoherently and her memory has
diminished to a marked extent.
Case XL — S. E. F., 19 years of age, seminary student, came to
the Clinic in 1899. His father and paternal uncles are alco-
holists. His mother is a nervous person; his grandmother on
the father's side is insane. He denies being an alcoholist him-
self, and says that he is free from syphilis. He states that he
is often troubled with excessive sexual excitement and frequently
with seminal emissions. He has always had mediocre capabilities
and suffered from indecision and doubts. He has been subject
to erotic obsessions quite a long while, but they did not interfere
with his daily work to any marked extent until two years before
his admission to the Clinic. During the last year preceding his
admission,- he had one attack of marked mental depression ; he
isolated himself from the world and worried; this was followed
by an attack of unwarranted exaltation: he wished to see as
many people as possible, he began to drink wine immoderately,
etc. The erotic obsessions from which he had suffered for a
long time now became of marked intensity. He explained that
this change was caused by his having seen a human skull in the
room of a friend. He was considerably worried about these
obsessions, considered himself as being an unpardonable sinner
and isolated himself and spent his time in crying over his misfor-
tune. His memory failed him, he was distracted, could not con-
centrate himself sufficiently to be able to read anything or to per-
form any work. He lost in body-weight, but still seemed to have
his faculties until about one year after the treatment was begun
at the Clinic. At that time, he complained bitterly of the erotic
obsessions, which he could not conquer. Everything about him,
every conversation leads him on to erotic obsessions; he tries
every possible remedy he can think of to master himself, but with
no results. In connection with these obsessions, he has another
obsession : he tries to resolve the question whether he is to blame
for these ideas or not. His mind seems now quite shattered : he
complains of some physician, saying that he is responsible for
some of the patient's trouble, and he becomes exhausted after
the slightest conversation.
Case XII. — B. S. P., 18 years of age, writer, came to the Clinic
in 1899. His father had disappeared; a brother is in prison;
his mother is tubercular. The patient has suffered from ob-
sessions since childhood ; they were at times of erotic nature. He
VERBAL DEAFNESS.— Van Gehuchten and Goris.
253
has always been subject to doubts, indecision, verifying every one
of his own acts. He could attend to his work, however. Lately,
he became disturbed by the obsessions to a degree that interfered
with his occupation, as he could not concentrate his mind on his
work. He isolated himself, remained in bed and refused to
answer questions addressed to him, saying that he was ashamed to
look people in the face. His mind seems to be giving way rapidly
and he seems now to be a dement.
The development of dementia after the onset of obsessions dem-
onstrates that isolated symptoms of diseases should not be taken
as a criterion for the definition of a whole disease ; the entire com-
plexus of symptoms should be considered before a proper diag-
nosis can be made. (Kraepeli, Einfuerung on die Psychiatrische
Klinik, 1901).
Our conclusions regarding the subject examined here are: 1, —
Subjects afflicted with morbid obsessions have morbid traits,
which are as characteristic and individual as are those found in
hysterical and epileptic persons ; 2, — these subjects generally have
some members in their families who suffer from similar morbid
disturbances, or at least from similar personal characteristics ; 3, —
these personal characteristic traits to which we refer are con-
genital psychic stigmata; 4, — when melancholia develops as an ac-
companiment of obsessions, it is generally found that it is de-
pendent on the nature of the obsessions.*
*Simultaneous publication in Journal S. S. Korsakova. Ed.
PURE VERBAL DEAFNESS.
A CASE OF PURE VERBAL DEAFNESS DUE TO AN
ABSCESS OF THE LEFT TEMPORAL LOBE.
TREPHINING— RECOVERY.
BY A. VAN GEHUCHTEN AND CH. GORIS.
Peripheral verbal deafness (Lichtheim) or subcortical sensory aphasia
(Wernicke), better called pure verbal deafness (Dejerne and Serieux) is
characterized essentially by the loss of comprehension of .spoken language,
inability to repeat words heard and loss of ability to write under dictation.
This form of aphasia is exceedingly rare in occurrence, especially when
the cases in which the auditory apparatus is injured are excluded; partic-
ularly, also, when exclusion is made of lesions of the labyrinth, which might
give rise to a symptomatology which we shall here consider {Freud).
254 VERBAL DEAFNESS. — Van Gehuchten and Goris.
There are only six cases of pure verbal deafness recorded in medical lit-
erature; in these cases lesions of the peripheral auditory apparatus are ex-
cluded; four cases were followed by autopsies. According to Thomas (i),
even this smaller number of cases should be examined with care.
The first case of pure verbal deafness was published by Lichtheim (2) in
1885. The case was that of a man, 55 years of age, who had an attack of
apoplexy, in 1877. This attack was followed by a slight paresis of the in-
ferior facial, on the left side, and by some disturbances of speech : para-
phasia during reading, repeated or spontaneous speech, and by paragraphia
while writing under dictation. These disturbances gradually faded away.
In 1882, a second apoplectic attack took place, and the facial paresis became
aggravated; the disturbances of speech which remained to a slight degree
also became more marked. They disappeared rapidly, however, but verbal
deafness, which persisted, took place during this attack; the patient could not
understand any word, although he could hear every noise produced about
him. There was loss of ability to repeat what was said to him as well as
to write under dictation. Spontaneous speech was absolutely cor-
rect, without there being manifested the slightest paraphasia. The intel-
ligence was intact and spontaneous writing was perfect ; the same was true
of the ability to read aloud and to copy in handwriting. This condition ex-
isted during a period of three years, at the end of which time the patient
died. No autopsy was performed.
Lichtheim and Wernicke (3) think, on the ground of theoretical consid-
eration, that there existed in this case a lesion in the white substance of
the left first temporal convolution. According to them, this form of sensory
aphasia is a focus symptom and should be considered as a consequence of
an impairment of cerebral perception of language.
Pick (4) published, in 1892, the first case of pure verbal deafness, with
an autopsy. This case was that of a man, 24 years of age, who had an at-
tack of apoplexy when he was 14 years old ; this attack was followed by a
slight degree of left hemiplegia and disturbances of speech. At twenty
years of age, a second attack took place and was followed by slight aphasia.
Three months before entering the hospital, a third attack took place and
was followed by some cerebral excitation. On examination, Pick discovered
the presence of verbal deafness, enfeebled intelligence and some other mental
disturbances. The patient gave the impression of suffering from complete
deafness : he paid no attention to noises made near him. It was found,
on attracting his attention, that he could not hear a soft noise
made by a slight ringing of a bell, or when called or spoken to in a low tone
of voice; but he could hear loud ringing of a bell, clapping or calling.
Spontaneous speech was unimpaired. There was complete loss of ability to
repeat words or to write under dictation.
Pick explains the observed symptoms by a supposition that the first apo-
plectiform attack caused a pathological focus in the right hemisphere and
that the transitory hemiparesis on the left side as well as the disturb-
ances of speech were the consequences of that focus ; that the second at-
tack produced a pathological focus in the left hemisphere and caused the
aphasia and probably verbal deafness. The fact that this verbal deafness
did not lose in its first intensity makes Pick suppose that there existed a
corresponding focus in the right hemisphere; this focus dated from the time
of the first attack, but produced no direct disturbances, he supposes. He1
concludes, from the above mentioned supposition, that there existed two
VERBAL DEAFNESS. — Van Gehuchten and Goris. 255
focuses of softening: one, in the right temporal lobe and the other, in the
left. This latter focus was supposedly located in the white .substance, ac-
cording to Lichtheim's theories. As regards the fourth attack, Pick sup-
posed that it caused a third focus in the gray basal ganglia as well as in the
internal capsule; the persistent left hemiparesis is thus explained.
The autopsy revealed lesions in both temporal lobes. On the right side,
the whole middle temporal convolution, the whole island of Reil and small
parts of the lower extremity of the anterior central convolution and the
lower frontal convolution were transformed into a soft, fluctuating mass, of
straw color. This lesion involved both the gray and the subjacent white
substance; the lesion involved also the anterior wall, the external capsule
and the external segment of the lenticular nucleus.
In the left hemisphere, similar softenings were found in the posterior half
of the superior frontal convolution and throughout the extent of the supra-
marginal convolution. This softening was more superficial than was that on
the right side ; the external capsule and the basal ganglia were intact.
Pick concludes from this case that Lichtheim's and Wernicke's opinions,
according to which sub-cortical verbal deafness is due to a lesion of the
white substance exclusively, are not justified.
Some years later, Ziehl (5) reported a new case of verbal deafness, in a
man, 75 years of age. On Dec. 24, 1891, he had a sudden attack of verbal
deafness with paraphasia. He could hear all noises made within range, but
could not understand words, nor could he recognize musical airs (amusia).
He could recognize some letters, however; he could not repeat what was
said to him and he manifested slight paragraphia. He could read aloud and
name objects shown him, although with slight paragraphia. This condition
persisted to the date of his death, — June 23, 1892. There was no autopsy
performed on the body.
In 1893, Serieux (6) published a case of a woman who, during the years
1887- 1892, presented a typical tableau of pure verbal deafness. At the end
of 1892, the conditions were as follows : "verbal and musical deafness, in-
tegrity of spontaneous speech, loss of the ability to repeat words, spontane-
ous writing and copying were normal, impossibility to write under dicta-
tion; mental and loud reading normal. Integrity of language. In 1892,
however, it became apparent that the symptoms of pure verbal deafness
were being coupled with sensory aphasia : there was paraphasia and para-
graphia, slight in degree at first, but increased progressively in intensity;
there was also impaired ability to read at sight. The symptoms of sensory
aphasia grew steadily worse, and jargonophasia finally set in; the patient
lost the ability to understand written language, her writing became incom-
prehensible, and even her signature looked altered. The acuteness of hear-
ing on the left side became gradually impaired, ending in marked deafness.
For some years there was deafness on the right side, which was caused by
an otitis. The intelligence became markedly decreased and the patient died
in March, 1893, when 55 years of age, eight years after the beginning of the
present disease.
The autopsy and histological examination of this case was made by De-
jerine and Serieux (7). They found a marked atrophy (almost half) of
both temporal lobes, which left bare the island of Reil. This atrophy de-
creases from above downward and antero-posteriorly, extending on either
side to the supra-marginal convolution and to the base of insertion of the
gyrus angularus. The latter seemed intact.
256 VERBAL DEAFNESS.— Van Gehuchten and Goris.
The histological examination showed that the lesion was exclusively cel-
lular,— that of chronic poliencephalitis. The communication fibres had dis-
appeared, the molecular layer was devoid of nervous cells, but there was a
larger number than normal of neuroglia cells and nuclei. The small pyra-
midal cells had disappeared, almost completely, through atrophy; the layer
of the large pyramidal cells was less altered, but the number of the cells was
below the normal. No trace of any focal lesion could be found."
Dejerine and Serieux conclude from this case that: I, pure verbal deafness
depends on a lesion purely cortical. (In Pick's case the lesion was both cor-
tical and central).
2, in pure verbal deafness the lesion is bilateral and is situated in the
temporal region, — the cortical centre of general hearing.
3, in pure verbal deafness there is, probably, no separation between the
centre of general hearing and the auditory centre of words, but there is a
weakening of the general centre of hearing.
Dejerine and Serieux's case seems, then, to completely refute Licht-
heim's and Wernicke's opinions regarding the subcortical origin of ver-
bal deafness.
In 1898, Pick published a second case of pure verbal deafness of which,
unfortunately, I have no detailed account (8). At the autopsy he found
lesions situated in both temporal lobes; thus, the opinions formulated by
Dejerine and Serieux are confirmed.
A more recent case, that of Liepmann (9) however, upholds the opinion
of Lichtheim and Wernicke.
A man, 67 years of age, presented, after two attacks of apoplexy which
caused right facial paralysis, verbal deafness, his hearing apparatus being
perfectly normal. This verbal deafness was accompanied, to a certain de-
gree, by psychic deafness. The condition of this patient remained sta-
tionary up to the time of his death, which was caused by a new apoplectic
attack. At the autopsy, an extensive hemorrhagic focus was found. This
focus completely separated the optic layer and the unimpaired part of the
corpus striatum from the cerebral cortex. The lesion had destroyed the
external capsule, the larger part of the corpus striatum and the internal
capsule. The right hemisphere was nprmal.
Liepmann concludes from his case that verbal deafness, in his patient,
must have been produced by a focus in the white substance of the left
temporal lobe and that this focus was masked by the final hemorrhage.
This proves, at any rate, that the disease could not have been the conse-
quence of a cortical lesion, as the cortical substance of the two tem-
poral lobes was intact. Liepmann comes back, then, to the opinions of
Lichtheim and Wernicke, according to which pure verbal deafness is really
of sub-cortical origin. More, he brings out the fact, contrary to Pick and
Dejerine's assertions, that the manifestation of pure verbal deafness does
not necessitate the presence of a bilateral lesion, as in his case the right
hemisphere was intact.
These few cases of pure verbal deafness are not free from criticism. Thus,
Thomas brings to light the fact that in Pick's first case there existed a
certain degree of paraphasia and that Ziehl's patient presented paraphasia,
paragraphia and paralexia. He inclines to the opinion that' these two cases
can be brought under the heading of sensory aphasia.
Dejerine and Serieux's case is not typical, either, of pure verbal deaf-
ness; because "the verbal deafness never existed by itself: from the very
VERBAL DEAFNESS.— Van Gehuchten and Goris. 257
beginning, there co-existed a slight degree of paraphasia and verbal am-
nesia; similar defects were found in spontaneous writing. Then, the dis-
turbances of speech and in writing increased with the verbal deafness ; one
can interpret, then, the symptoms in the beginning as having been those of
early sensory aphasia ; and those which came on later, — as symptoms of typ-
ical sensory aphasia, which differed from the majority of such published
cases by the extremely slow course."
This sensory aphasia became slowly transformed into total deafness.
Thomas says : "The lesions found at the autopsy should be regarded rather
as those of total deafness than lesions of pure verbal deafness. As these
lesions were exclusively cortical, it is also well to suppose that the almost
pure verbal deafness, which existed in the beginning of the affliction, was
also of cortical origin."
Thomas says that if we admit, with Dejerine and Serieux, that the ver-
bal deafness of their patient was of cortical origin, we cannot admit that
their case has furnished the proof of the necessity of a bilateral lesion for
the production of verbal deafness, for there is nothing to prove that the
verbal deafness alone existed when the lesion was bilateral.
According to Thomas, Liepmann's case may be considered as being the
most schematic one of pure verbal deafness. Thomas supposes that in Liep-
mann's case there must have existed a sub-cortical lesion, which interrupted
the course of the projection fibres of the temporal convolution and caused the
verbal deafness. He thus comes to the conclusion that there are two va-
rieties of pure verbal deafness: a sub-cortical and a cortical verbal deaf-
ness.
Dejerine and Serieux's case has also been criticized by Liepmann (10)
as to the correctness of its diagnosis. He points out the fact that the fac-
ulty of repeating words heard was not lost completely. The patient could
repeat part of the questions addressed to her without understanding their
sense. Nor was there complete loss of the ability to write under dictation :
she translated into writing the words heard, in the sense of sounds per-
ceived ; the errors in that writing were due to the fact that she did not un-
derstand the words. There was, then, according to Liepmann, no loss of
ability to repeat words, but a certain degree of echolalia, with loss of com-
prehension of words which she repeated ; in other words : there was conser-
vation of what Liepmann calls Wortlautverstaendniss and loss of what he
calls W ortsinnverstaendniss.
Veraguth (11) lately published another case of transitory verbal deafness,
with an autopsy, but the diagnosis of the case is not free from all criticism.
A man, 42 years of age, with no hereditary stigma, but with a somewhat
feebly resisting nervous system, impaired by a previous typhoid fever, sus-
tained a cranial traumatism, probably following some alcoholic abuse. This
accident was followed by some disturbances of sight: inequality of the
pupils, concentric narrowing of the visual field for colors, a certain degree
of dyslexia as well as some general psychic impairment. Some six months
after this accident, following the abuse of alcoholic drinks, pure verbal deaf-
ness set in, without the accompaniment of any other speech disturbances.
This deafness lasted only four days and disappeared suddenly, after a pro-
fuse epistaxis. The patient died, one year later, from endocarditis.
At the autopsy, Veraguth found a marked atrophy of the left hemisphere,
involving the posterior or opercular part of the inferior frontal convolu-
tion. This part of the convolution was entirely destroyed and replaced by a
258 VERBAL DEAFNESS.— Van Gehuchten and Goris.
serous liquid. A similar lesion existed at the site of the middle portion of
the first temporal convolution. In this region, there was also a collection of
serous fluid between the brain and its coverings. The first temporal convo-
lution was; narrow ; the first temporal fissure was three centimetres deep ;
the central, paracentral and inferior frontal fissures were of the same depth.
In the right hemisphere, the narrowness of the first temporal convolution
was most remarkable.
The cerebral white substance was reduced in its totality.
A microscopic examination showed that the gray substance of the atro-
phied convolutions was narrower than usual. The same was true of the
sub-jacent white substance. There was no trace anywhere of any focus in
either the cortical or the medullary substance. Specimens prepared by Nissl's
methods do not indicate any clue to the cause of the reduction of the gray
substance.
Veraguth draws the following conclusions from this case:
1, pure verbal deafness may exist without there being a sub-cortical fo-
cus-lesion in the left temporal lobe. In this respect he approaches his case
to that of Dejerine and Serieux; more, he ascribes to it a more important
value. He seems to think that the lesion described by him is the minimal
observed up to now in patients who have suffered from verbal deafness.
2, the bilateral atrophy of the first temporal convolutions supports Pick's
and Dejerine' s opinions, according to which the onset of pure verbal deaf-
ness must be preceded by a bilateral cortical lesion, against Liepmann's as-
sertions to the contrary.
3, Pure verbal deafness may exist, without there being necessarily any
marked microscopic changes in the auditory tract, uniting the cerebral cor-
tex with the auditory nerve.
4, As the labyrinths were intact, Veraguth's case only confirms the rule:
verbal deafness is caused, in reality, by a lesion of cortical origin.
We regret to find it necessary to say that none of Veraguth's conclusions
■seem to be justified.
We are of opinion that there is no relation between the cerebral lesions
found by Veraguth and the transitory verbal deafness of his patient, for the
simple reason that if these cerebral lesions had been the causes of the verbal
deafness the latter should have persisted to the end of life; but the verbal
deafness existed only four days, and the patient lived on over one year after
the disappearance of this verbal deafness, without presenting any symptoms
of disturbances in articulate speech. The brain of Veraguth's patient cannot,
therefore, be considered as being one of a patient who had suffered from
verbal deafness.
Veraguth's case cannot, therefore, be likened to Dejerine and Serieux' s
and we cannot admit the conclusion regarding a minimal lesion apt to
cause verbal deafness ; for the lesion which was the cause of the verbal deaf-
ness did not exist at the time of the autopsy.
He does not prove anything, either for or against the indispensable bilat-
eral cerebral lesion.
Veraguth seems to have recognized the small value of his conclusions, for,
after having formulated them, he admitted himself that there was a con-
tradiction between the clinical and the anatomical tableau. He asks how it
was possible for the verbal deafness of his patient to have been transitory
when the autopsy showed the presence of a bilateral atrophy of the first
temporal convolutions ; and, trying to answer his own question, he concludes
VERBAL DEAFNESS.— Van Gehuchten and Goris. 259
that in his case the sub-cortical sensory aphasia must enter under the head-
ing of functional disturbance. He finally concludes that the determining
cause of this verbal deafness was due to a local circulatory disturbance,
slight and transitory, in the corresponding branch of the Sylvian artery.
We think, with Veraguth, that this is the only plausible explanation of
the verbal deafness observed by him and that the atrophy of the temporal
convolutions has nothing to do here with the sensory aphasia.
If we admit the circulatory disturbance to have been the cause of the
transitory verbal deafness we differ, however, with Veraguth's final con-
clusion, according to which he also brings into play the atrophy of the tem-
poral convolutions.
The absence of verbal deafness during a whole year after recovery from
the transitory spell, proves, in our opinions, that the atrophy of the con-
volutions does not constitute part of the mechanism of this deafness. Be-
sides, there is nothing to prove that this atrophy of the temporal convolu-
tions existed when the verbal deafness set in; there is no proof that the
transitory circulatory disturbance was not, in itself, .sufficient cause for the
trouble, and that the convolutions were not normal at that time.
Consequently, the cause of the verbal deafness in Veraguth's case cannot
be easily determined. The positive point, however, is that the cerebral at-
rophy found at the autopsy could not have been the sole cause of the deaf-
ness.
Verbal deafness is not always of cerebral origin. Bleuler (12) called
attention to the fact that the loss of comprehension of words may be due to
external physical causes, independent of the auditory apparatus. Thus, one
may hear, sometimes, perfectly all that is going on in an adjoining room,
even the slightest noise, even recognize the individual voices of the
speakers and yet not understand the words spoken, or else understand them
only incompletely. Freund (13) called attention to the fact that loss of
comprehension of words may also result from a lesion of the labyrinth or
even from that of the middle ear.
It were well, then, in all cases of verbal deafness, to examine carefully the
various parts of the auditory apparatus in girder to separate distinctly verbal
deafness of central from that of peripheral origin.
We must also call attention to the fact that there is a true verbal deafness
of hysterical nature, which might be confounded, at first sight, with cortical
or sub-cortical verbal deafness. Raymond has recently reported two such
cases to the Neurological Society of Paris. The diagnosis may be difficult,
especially in cases like Raymond's; the duration here was eleven months
in one and nine years in the other case, regardless of the treatment applied
with a view to re-educating the sense of hearing and regardless also of the
application of hypnotism.
Recently, we have had occasion to handle a case of pure verbal deafness,
incontestably of cerebral origin, which seems to have furnished us an irre-
futable proof that pure verbal deafness can be caused by a unilateral lesion,
implicating the left temporal lobe exclusively. This pure verbal deafness
presents still another particular interest: the deafness was caused by an
abscess of the left temporal lobe, the abscess having extended from an ab-
scess of the middle ear ; trephining enabled us to empty the pus and to bring
about retrocession of the grave symptoms of cerebral origin.
The patient was a man 40 years of age, and suffered from otorrhoea on
the left side, since he was three years old. The running from the ear was
26o VERBAL DEAFNESS. — Van Gehuchten and Goris.
intermittent in occurrence. Last December, the discharge was accom-
panied by a headache in the left frontal region. An orlst treated the ear
during the course of a month's time, using antiseptic injection and sed-
atives.
As the discharge continued, one of us was called in consultation, on
January 15. The patient, who was up and about on the previous day, was
now confined to his bed, complaining of a bad headache in the left frontal
region, which caused him insomnia. As he was giving the history of his
illness, he was interrupted and asked whether he had pain elsewhere than
in the frontal region ; he answered : "Some beef-tea, some very good beef-
tea, ask my wife." The patient did not understand what was said to him,
although he could express perfectly what he wished to say. This was the
first manifestation of his verbal deafness. The family informed us that
within the last few days it had been noticed that the patient's behavior
had changed : He was generally reserved, .serious, secretive, especially
regarding matters of his business; but that he had become communicative
to a point of talking about his business with any one who wished to
listen to him.
The examination of the sore ear revealed the presence of a large perfor-
ation of the ear-drum and of a fetid pus in the ear. The hearing was very
acute on the right side, but almost abolished on the left. There had never
been any febrile movements.
It was decided to operate on the patient, and on January 16, the mastoid
was found filled with pus down to the point of this bone; there was de-
struction of bone so that the lateral sinus behind and the dura mater of the
upper plane of the antrum above were exposed. In both these places the
dura mater was of normal color. For this reason the surgical interven-
tion was not pushed any farther, so much the more that according to
Broca the emptying of the mastoid is often followed by a disappearance of
the cerebral symptoms.
The patient was much improved the next day, he understood to a certain
degree words addressed to him, and the temperature was below 37 de-
grees C.
On the morning of the 19th, the temperature rose to 37.8 degrees C, and
the improvement of the previous night had disappeared : the verbal deaf-
ness was complete. In the evening we examined the patient thoroughly.
There was complete absence of either motor or sensory disturbances
and there were no ocular signs. The pupils were normal, and an ophthal-
moscopic examination by Drs. Demets and Gauthier gave negative results.
The verbal deafness was absolute: the patient did not understand any
question addressed to him. He did not seem to understand the sound of
the voice, because, in answer to every question asked, he repeated: "To-
morrow I shall be better," or else "I accept the augury," "it is sad, is it
not?" "Do you think I shall be better? Ask my sister, is that not so sis-
ter?" He could also hear other sounds, as, the ticking of a watch; with
his right ear he could hear this sound at a marked distance.
There was no verbal blindness : written questions were read aloud cor-
rectly, and proper answers were given. There was no paraphasia. Spon-
taneous speech was normal and correct, but there was a certain tendency
to talkativeness. There was complete loss of the ability to repeat words.
He was not examined as to his ability to write under dictation.
As the existence of pure verbal deafness was incontestable, and in view
VERBAL DEAFNESS.— Van Gehuchten and Goris. 261
of the presence of pus in the mastoid apophysis, the diagnosis could not
be doubtful : we were certain of the existence of an abscess of otitic origin,
located in the left temporal lobe.
An operation was performed at six o'clock in the evening. A trephine,
two centimetres in diametre, was used and applied three centimetres above
the auditory meatus. As the button of bone was being taken off, the sound
slipped through the dura mater, along the anterior border of the opening,
and must have penetrated into the cerebral substance, for as soon as the
button was lifted, a liquid pus began to escape from under the dura mater.
After this accidental sounding, a canula sound was introduced into the
temporal lobe. It gravitated by its own weight to a depth of from 6 to 7
centimetres, following an oblique direction downward and backward. A
drainage tube was introduced in place of the probe, and a considerable
quantity of pus escaped. The tube was left there for slow drainage of the
abscess.
According to Dr. Morelle's report, the pus was aseptic.
In order to hasten the evacuation of the pus, aspiration was made twice
daily with a syringe adjusted to the drainage tube. Until January 25,
amelioriaion went on .slowly, and the drainage tube was then taken out.
This was a bad stroke, as in the evening the condition of the patient was as
bad as it was before the operation was performed. The drainage was put
back, and after the removal of a slight quantity of pus, the new alarming
symptoms disappeared.
On January 28, the patient understood correctly certain questions ad-
dressed to him, but some questions he did not answer properly. He
asked to be given the daily papers and interested himself actively in the
commercial news. The cerebral wound then measured 55 millimetres in
depth. On that day he presented paraphasia. Thus, when shown the
queen of diamonds and asked to name her, he said: "It is the queen of
circumscription." When shown the ace of diamonds, he said: "It
is the ace of circumscription^."
The verbal deafness was decreasing, however, from day to-day.
On January 30, we asked one of his business friends to have a conver-
sation with him, and he spoke without showing any defects of speech.
On February 4, the wound was still 5 millimetres deep. The patient
complained insistently of his confinement to the ward, and regardless of our
advice to write to his family, he refused to accede to our request. When
we finally succeeded in making him write a letter, he no sooner wrote a
few lines than he refused to continue: there was evident paragraphia.
The following lines are the examples :
"Priere faire exped. d'un copie pour compte de mon frair 9 rue du
a Bruxelles, au consulat-syndicat a mon."* Then followed some words
written in an incomprehensible manner.
At that time the verbal deafness existed to a certain degree. There
were moments when the patient understood everything, and others when
he could not understand anything. His condition had changed for the
better, however, and there seemed to be improvement daily. On February
7, at 8 o'clock in the morning, the drainage tube reached 2 centimetres deep
in the wound, and in the evening it could be pushed in only 1 centimetre.
The following day the tube was taken out, and the patient left the hos-
pital 8 days later. At times he showed no trace of verbal deafness. He
*These lines are untranslatable for obvious reasons. Translator's note.
262 VERBAL DEAFNESS.— Van Gehuchten and Goris.
has been seen twice since that time by one of us. The recovery has been
absolute. On March 27, the patient was actively engaged in the discharge
of his important business.
In order to locate the precise spot in the temporal lobe, where the sur-
gical operation was performed, we trephined a head of a corpse, of a man 25
years of age, according to the indications given by us above. After the inci-
sion of the dura mater, we introduced through the opening a wooden stick,
the thickness of the drainage tube used in our case, the length of the stick
being 5 centimetres. It was distinctly seen on the brain hardened in
formol that the stick penetrated into the temporal lobe through the middle
part of the second temporal convolution.
An incision made through the plane where the stick was lodged, in the
temporal lobe, shows that the section passes through almost the entire
thickness of the temporal lobe below the corresponding prolongation of
the lateral ventricle.
From the point of the etiology, it seems to us of importance to bring to
light the fact that in the majority of the cases of pure verbal deafness,
recorded up to this date, the patients had apoplexy. There are no excep-
tions in this regard, save Dejerine and Serieux's patient, in whom the ver-
bal deafness was due to a chronic poliencephalitis ; Ziehl's case may also
be considered as being an exception, but unfortunately there was no
autopsy on the body. Our case was the first, in whom pure verbal deaf-
ness was caused by an abscess of the left temporal lobe.
As regards the ultimate course of the verbal deafness, we notice that in
the published cases this deafness persisted up to the time of death. Our
case is the only one, in whom the verbal deafness, unquestionably due to
a cerebral lesion, could be cured through surgical intervention.
Our case also demonstrates most clearly that pure verbal deafness can be
the consequence of a localized unilateral lesion in the left temporal lobe,
in accordance with Lichtheim's, Wernicke's and Liepmann's opinions.
Our case also furnishes proof of the important point that the gravity of
the symptom, verbal deafness, is not always due to destruction of either
the cortical or subcortical nervous substance; also that this symptom may
be an external translation of a .simple compression acting either on the
gray matter of the superior temporal convolution, or on the sub-jacent
fibres. For, if, in our case, the cerebral abscess had destroyed the fibres
or the cortical regions, the integrity of which are indispensable for the
comprehension of heard words, the opening of that abscess and the evac-
uation of the pus would have had no influence on this deafness. In or-
der to explain the recovery which took place, we must admit that the ver-
bal deafness was here the consequence of temporary suspension of the
function of these fibres or of this cortical region caused by compression.
It is evident that our case of pure verbal deafness cannot thoroughly elu-
cidate the mooted question concerning the cortical or sub-cortical seat of
pure verbal deafness, as the compression caused by the abscess may have
made itself felt in both, — the gray substance and in the sub-jacent fibres.
We do not think that the diagnosis of pure verbal deafness in our case
can be contested on account of the presence of some paraphasia and para-
graphia. We think that the paraphasia which he presented was nothing
else than a direct consequence of his verbal deafness; we do not wish to
be understood as saying that pure verbal deafness must inevitably be
coupled with paraphasia; but we simply remark that paraphasia might be
VERBAL DEAFNESS.— Van Gehuchten and Goris. 263
produced during the course of pure verbal deafness. When we showed
our patient the play card, he wished to say, we think, "queen of dia-
monds;" he thought that he was saying this, although he pronounced the
words "queen of circumscription;" this was simply because, being subject
to verbal deafness, he could not control the correctness of the words which
he used. A similar paraphasia is often met with in normal persons
who, for some reason or other, fail to keep track, by the sense of hearing,
of spoken words.
Dejerine, who has contributed so much to the elucidation of this question,
is also of our opinion.
It is more difficult to explain the presence of the paragraphia which our
patient presented, as his intelligence was intact and as there was not the
slightest index of the presence of verbal blindness.*
REFERENCES.
1. THOMAS. La surdite verbale. La parole, Paris, 1900.
2. LICHTHEIM. Ueber Aphasie. Deutches Arch. Klin. Med., Bd.
36, p. 238, 1885.
3. WERNICKE. Die neueren Arbeiten ueber Aphasie. Fortschritte
der Med., p. 371, 1886.
4. PICK. Beitraege zur Lehre von den Stoerungen der Sprache, Arch,
f. Psych, und Nervenk., Bd., 23, pp. 909-913, 1892. .
5. ZIEHL. Ueber einen Fall von Worttaubheitt und des, Lichtheimsche
Krankheitsbild des subcortical en sensorischen Aphasie. Deut. Zeit. f. Ner-
vernheilk., Bd. 8, p. 258, 1896.
6. SERIEUX. Sur un cas de surdite verbale pure. Revue de Med-
icine, p. 733, 1893.
7. DEJERINE ET SERIEUX. Un cas de surdite verbale pure terminee
par aphasie sensorielle, suivi d'autopsie, Soc. de biol., 1897.
8. QUOTED AFTER DEJERINE. Semiologie du systeme nerveaux, p.
414, 1900.
9. LIEPMANN. Ein Fall von reiner Sprachtaubheitt, Psychiatrische
Abhandlung, 1898 (Neurol. Centr., 1899, p. 26).
10. LIEPMANN. Ein Fall von Echolalie, Neurolog. Centralb, 1900.
11. VERAGUTH. Ueber ein Fall von transitorischen reiner Wort-
taubheit, Deutsche Zeitsch. f. Nervenh., Bd. XVII, pp. 177-198, 1900.
12. BLUELER. Zur Affassung der subcorticalen Aphasien, Neurolog.
Centralb., 1892.
13. FREUND. Labyrinthtaubheit und Sprachtaubheit, Wiesbaden, 1895.
*Nevraxe, Vol. Ill, fasc. I.
THE GENESIS OF EPILEPSY CLINICALLY CON-
SIDERED. THE PATHOLOGY, PROPHYLAXIS
AND TREATMENT OF EPILEPSY.
ILLUSTRATED BY CASES AND STATISTICAL TABLES.
BY LOUISE G. ROBINOVITCH, B: ES L. (PARIS), M. D.
Foreign Associate Member Medico-psychological Society, Paris; Member New York
Academy of Medicine.
( Continued. )
PROPHYLAXIS.
The importance of this subject prevents me from treating the
question in the worn phrases and sentences that bespeak nothing
higher than cant. To say that the evil can be eradicated by
means of benevolent and charitable aid devoted to improving the
moral tone of the poor and ignorant is idle waste of time and space
and paper. The inefficiency of these measures is too well known
to the clinician as well as to the families whose lot it is to bear
the stigma of being members of an alcoholic's breed. Be-
sides, it is not fitting for the scientist to commit such a gross error
of reasoning as to presume that alcoholism is a disease of the poor.
Alcoholism is a disease, but like insanity, it attacks indiscriminately
both rich and poor. Therefore, when we provide a prophylactic
measure it must be sufficiently flexible to indicate the help for both
classes.
I do not wish to be understood as saying that the charitable and
benevolent work that helps lessen alcoholism among the poor
should be abandoned. On the contrary, let those who are en-
gaged in this laudable work continue in their efforts and help
raise the level of human morality. The results obtained from
the efforts of societies which provide for the improvident drunk-
ard, either by enacting workhouse reforms or by establishing sys-
tems of employment to suit the subjects in question are gratifying.
But the gratification is rather of a relative measure when compared
with the results that could be obtained from a system of which I
shall speak presently.
At the Fifth International Congress of Criminal Anthropology
held at Amsterdam, September, 1901, I had occasion to speak
of what would constitute a rational measure in the prevention
of the birth of crime and of its propagation. I held that proper
instruction as well as education begun in early childhood were in-
valuable social measures for the above purpose. This opinion was
GENESIS OF EPILEPSY.— Dr. Robinovitch. 265
based on a study of reformed prisoners at the New York State
Reformatory at Elmira. The conclusions I drew were these : if
an inveterate drunkard criminal can be transformed into a sober
and industrious citizen by means of a rational education, then
is it possible to prevent a subject from becoming a drunkard
and criminal by giving him a rational education before his nature
becomes vitiated — when he is yet a child.
We need a thorough understanding of what constitutes an edu-
cation; the latter is imperfectly understood to-day, if we are to
judge the acceptance of the term by that which is meted out as an
"education" in our schools.
The principles of self-restraint as well as of accommodation to
the restrictions and deprivations of life should be taught from early
childhood.
As I must curtail this paper, I shall only remark that, unfor-
tunately for our nation, the medical profession has not yet divested
itself of that garb of easy tolerance which, when closely analyzed,
is suggestive either of hypocrisy in or indifference to this question.
But some physicians and our medical press, with the keenness pe-
culiar to this country, are already presenting the question of alco-
holism in the light brought out by clinical observation, and we may
feel confident that the time is not distant when the members of our
profession will cease allowing the fear of ignorant ridicule to in-
terfere with their sacred duties.
CONCLUSIONS.
From the arguments adduced in this paper, I conclude that : —
A clinical study of the genesis of epilepsy shows that this convul-
sive disease is intimately connected with ancestral alcoholism.
When closely traced to its origin, epilepsy appears to have its
source, in great part, in epileptiform convulsions of alcoholic na-
ture in the antecedents.
Where alcoholism in the father or mother, or in both, is absent,
it is often found that alcoholism existed among the grand-parents ;
and where the history is not sufficiently clear to incriminate any
of the direct ancestry, the morbid predisposition is often indicated
by the existence of alcoholism in the direct collateral family.
Epilepsy may be transmitted from an epileptic parent directly to
the offspring.
Epilepsy may be transmitted through a generation free from the
manifestation of the disease ; the hereditary nature of the malady is
then generally proven by the discovery of the existence of epilepsy
in the direct collateral family of the preceding generation.
266 GENESIS OF EPILEPSY.— Dr. Robinovitch.
Insanity, neuroses, psychoses and criminality are often causes
of epilepsy in the offspring.
The acute contagious and infectious diseases occurring during
pregnancy may cause epilepsy in the child; but it is a question
whether these causes are to be accepted as the sole factors in the
causation of the disease, — predisposing causes should be looked
for.
The chronic organic diseases cannot be accepted as the sole re-
sponsible factors in the causation of epilepsy.
Syphilis, like other diseases, cannot be accepted as a specific
factor in the causation of epilepsy.
Microscopic cerebral pathology shows that an intimate identity
exists between the morbid changes found in alcoholism and those
found in epilepsy.
This fact is logical because alcohol stands, clinically, as the
main cause of epilepsy.
Alcohol taken in excess in the form of wines, etc., does not
cause true epileptic attacks ; epileptiform convulsions are the rule
in such cases so far as the original alcoholist is concerned ; but the
offspring of such subjects inherit true epilepsy.
Excessive use of absinthe causes true epileptic convulsions in the
original alcoholist. The offspring then inherit epilepsy in the same
manner as the offspring of the ordinary alcoholist.
The birth rate is low and the death rate is high in the alcoholic
family, — the death rate being particularly high during infancy and
the cause of death during this period generally being meningitis
with convulsions.
Of 140 cases of epilepsy considered, 90 cases had direct parental
alcoholic heredity, making a percentage of 64+.
Considering the causes of epilepsy, it is evident that the prophy-
laxis is the most important agent for checking the growth of the
disease.
All the cases and documents cited in this paper were studied in Dr. Mag-
nan's wards.
(The second part of this paper will be continued in Vol. HI.)
The Journal of Mental Pathology.
Edited by Louise G. Robinovitch, B. es L., M.D.
Vol. II. JUNE, 1902. No. 5.
STATE PUBLISHING COMPANY, Publishers,
290 Broadway, NEW YORK.
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28 West 126th Street, New York.
Address bulky mail matter to P. O. Box 1023, New York.
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Original researches and other MSS. will be carefully considered, and if
found unsuitable will be returned, if accompanied by stamped, self-
addressed envelope. News items from Institutions will be given all space
available.
PHILOSOPHIC RESEARCH VERSUS REALITY.
The philosophy of national existence is always of great inter-
est: the subject of ethnological psychology does not, however,
lend itself easily to analysis. The main reason of this difficulty
lies in the fact that nations, like individuals, are in reality not
concrete units; far from being that, their psychological develop-
ment is accidental in proportion to this or that tide that con-
tributes towards the foundation or disintegration of this or that
form of national government, institution or other function of
importance in the existence of a people. Professor E. Murisier
publishes an article entitled La Psychologie du Peuple Anglais
(Archive de Psychologie, April, 1902), in which he has under-
taken the arduous task of handling the fickle question of the psy-
chology of the English nation and of its ethology. He considers
the various traits of psychic development of that nation and con-
cludes, on the whole, that although the Englishman prides him-
self on his individuality, as such, he does not, under all circum-
stances, seem to be true to his psychic picture of himself ; he is
more a concrete creature than he is an idealist ; the fact becomes
most evident when examining the English Fine Arts, Music,
Politics, etc. The pre-eminent trait of the Englishman is his ir-
repressible tendency to activity, as well as his insatiable desire to
26S EDITORIAL.
conquer; and yet, he is more bound down by what is commonly
known as cant than is any other man in the civilized world. The
English woman, when considered in her two stages, — as a girl and
as a matron, is also an enigmatic compound of contradictions that
belies the existence in her of the true spirit of independence; yet
the Englishman is an admirer of this trait of independence, which
is found in Germany and in France. Stuart Mills, the author
goes on to say, was so charmed with it in France that he almost
venerated the atmosphere of freedom, which he tasted there.
Idealism, we are informed, also exists to a larger extent in the
Latin countries than it does in the English domain. Space does
not permit our examining here the exact value of idealism as it is
commonly understood, and the loss that accrues to the English be-
cause they lack this trait. We wish to remark, however, that, to
us, there seems to exist a large amount of Utopian reasoning in
the philosophers' studies of peoples ; philosophers are often apt to
see life not as it is in reality, but as they think it to be from the
sketches they read while burning the midnight oil. They seem
to base their works on conclusions that are often the results of
sheer artificial constructions ; they expect the world, then, to take
their teaching in earnest.
We do not have to go far to prove that nationality, national
psychology, ethology of nations, etc., etc., are nothing more than
artificial products of some narrow-minded constructions which are
forcefully brought about and eventually perpetuated by laws and
regulations, and which have succeeded in reducing the broad entity
of man to a being with some traits varying according to the geo-
graphical origin of those laws and regulations; ample proof of
this is seen in Europe. In the United States, where individual
life is most developed, because, thus far, it has been unhampered
by traditional restrictions, we again find ample evidence
to support our argument. If the European philosophers
were to come over here and study the people as they
are they would easily recognize the artificiality of their
constructions regarding the inherency of national weaknesses, de-
fects and other national traits. Here, the American-born French-
man or Italian is none the less adapted to his surroundings be-
cause he is inherently more disposed towards idealism than is his
neighbor, whose parents were born in England ; and the descend-
ant of Albion is not at all a menace to the descendant of Gaul be-
cause of the former's propensity to "conquer"; even the pro-
foundly idealistic German has thus far managed to keep up quite
creditably, in the struggle for existence, with his more practical
minded neighbors, the English and their descendants.
EDITORIAL. 269
We learn with great pleasure the news of the promotion of Dr.
V. Magnan to the grade of officier de la Legion d'Honneur. We
address our sincerest congratulations to the physician of Ste-Anne
and our distinguished associate editor.
HONORS TO THE FOUNDER OF THE Revista Speri-
mentale di Freniatria.— Professor AUGUSTO TAMBURINI
founded the "Revista" twenty-five years ago, and to-day this is the
most valuable publication on psychiatry and neurology. His
friends and admirers celebrated the occasion of the 25th anniver-
sary of the Journal, at Reggio Emilia, at the Hospital for the In-
sane, which has grown into a centre of learning under his vigilant
direction ; he holds to his credit also the breaking down of the old
methods of the treatment of the insane and the substitution of the
newest and scientific measures at the Reggio Emilia Asylum for the
Insane. The volume of December, 1901, is dedicated to Professor
Tamburini and appropriate inscriptions and expressions of grat-
itude by his friends are presented on the first pages of the volume.
MEETINGS.
Congress of French Speaking Physicians of North America.
Quebec, June 25, 26 and 27 ; the meeting will be held in connection
with the semi-centennial celebration of Laval University.
Congress of Alienists and Neurologists of French and French-
Speaking countries, at Grenoble, August 1-8, 1902. Prof. Regis,
University of Bordeaux, is the President.
International Congress of Care for the Insane, Antwerp, Bel-
gium, September 1-7, 1902. Dr. Peeters, President, colony of
Ghee.
DEATH OF CHARLES LETOURNEAU.— The distinguished scientist
Charles Letourneau, died February 21, 1902. His numerous works on an-
thropology and anthropological ethnology are well familiar to the learned
profession. The Paris Society of Anthropology was fostered by him and
stimulated in its progressive growth. Only two months before his death
he completed a most important work, "La Psychologie Ethnique," which
was analyzed in our issue of March, 1902. An autopsy was performed on his
body and his brain was taken to the laboratory of the Society of Anthro-
pology. The brain weighed 1,490 grams; the brain alone, without the
cerebellum, weighed 1,318 grams. This weight is about 150 grams above
the average weight.
We learn with much regret that Dr. Kogevnikoff, Professor of
neuro-pathology, at the University of Moscou, is dead.
270 RE-EDUCATION OF DEMENTS.
AN OPENING FOR INTERNES IN 5TATE HOS-
PITALS.—Lodging and board is offered to young medical grad-
uates, who wish to serve as medical assistants in the various
New York State Hospitals for the Insane. No examination is re-
quired ; application must be made in person to the superintendent
of the chosen Hospital, or else, to the Commissioner in Lunacy, at
4 West Fiftieth street, New York City.
SERUM THERAPY is gaining ground in the domain of therapeutics.
It is applied to varied diseases (nervous and mental diseases, hysteria, phy-
sical debility and chronic auto-infection). At 58, rue Douai, Paris, has
been established an Institute called Serumtherapy, and a resident physician
is kept busy with this newest method of treatment.
A CASE OF HYSTERICAL OEDEMA OF SEGMENTARY DISPOSI-
TION.—DRS. PIERO GONZALES AND PAOLO PINI : The study is
interesting from the standpoint of a differential diagnosis, which the authors
consider in detail. Their case presented a sudden onset of an epileptiform
attack, which was, followed by scattered areas of cedema all over the body.
The patient suffered, at the same time, from impaired general and special
sensibiliy. She was cured of the cedema, has had several other attacks
of the same disturbance and is well of it at present. The authors suggest
that some cases of scleroderma reported to have been cured belong, per-
haps, to the class of hysterical troubles of a nature similar to the one here
examined. (Annali di Nevrolgia, Anno XX, fasc. 1.)
From the American Journal of Insanity, April, 1902.
1. ETIOLOGY OF PARESIS.— DR. ARTHUR W. HURD : . Syphilis
is the most common factor in the production of paresis ; it may be a direct,
exciting cause, or an indirect cause, — by devitalizing the system and thereby
predisposing it to the ailment; syphilis is not usually the sole cause of the
disease: mental stress, overexcitement, dissipation, alcoholism and heredity
are generally associate causes ; in a relatively small number of cases, mental
stress, worry and over-work may be the sole ascertainable causes ; trauma-
tism may be the cause in a small number of cases, but syphilis generally
underlies as a cause.
2. THE EARLY DIAGNOSIS OF PARESIS.—DR. F. X. DER-
CUM : It is relatively easy to make a diagnosis of paresis after the initial
stage has passed, but it is most important to recognize the existence of the
disease at the earliest possible moment; therefore, cases of chronic fatigue,
— neurasthenia, should be carefully studied and signs of mental weakness
and of degeneration detected when possible.
3. THE COMPARATIVE FREQUENCY OF GENERAL PARE-
SIS.—DR. CHARLES G. WAGNER : General paresis constitutes 8.75 per
cent, of all cases of insanity ; it occurs most frequently between the ages of
30 and 50; the frequency of its occurrence, is increasing; men are about 7
times more liable to this disease than are women; the termination of this
disease is fatal, its course extending over a period of some 2^2 years ; it
is nearly twice as frequent in occurrence in large cities as it is in the coun-
TREATMENT OF PARESIS. 27 1
try; heredity, syphilis, infection and alcoholic excesses are important fac-
tors in its production; members of the learned professions, — teachers, mu-
sicians, actors, etc., do not seem to be especially predisposed to this dis-
ease ; intellectual work or any special occupations do not seem to predispose
individuals to paresis; but the general cerebral strain with more or less
hereditary influence is found to have existed in the majority of cases.
Over-work, sexual excesses, alcoholism, irregular habits in sleeping and
eating and accidents — as sun-stroke, cerebral traumatism — appear to be the
great factor in the production of this disease. In all the recorded cases
examined by the author, only one case is said to have made a recovery.
4. TREATMENT OF PARESIS; ITS LIMITATION AND EXPEC-
TATIONS.—DR. EDWARD COWLES : The theories regarding the path-
ogenesis of general paralysis are various; Dr. Robertson thinks that the
vascular changes are the first to manifest themselves ; these vascular changes
are caused by intestinal bacteria, the products of which attack the vascular
walls first ; this fact seems to be of clinical importance, as appropriate treat-
ment in due time can arrest the progress of the disease; the limitations in
treatment are many at the present day and the treatment must follow the
indications furnished by scientific research.
5. HEREDITY— WITH A STUDY OF THE STATISTICS OF THE
NEW YORK STATE HOSPITALS.— DR. WILLIAM C. KRAUSS : An
exhaustive study of heredities is presented ; the latest figures are given here :
Percentage showing heredity, exclusive of unascertained, cases, 1899- 1900,
36.6; since 1888, 39.7. Percentage showing no hereditary tendency, ex-
clusive of unascertained cases, 1899-1900, 63.3 ; since 1888, 59.8. Total num-
ber of cases admitted, 1899-1900, 1,202; since 1888, 61,257. Esquirol claimed
that maternal heredity was three times more common and much more seri-
ous than was paternal heredity. Baillarger found, in 453 cases of insanities,
maternal heredity 271 times, while paternal heredity occurred 182 times.
The reports of the New York State Hospitals show that maternal heredity
is increasing rapidly over paternal heredity. In nervous diseases the hered-
itary influence is also marked ; tabulated data are given to this effect.
6. SOME OBSERVATIONS ON THE ELIMINATION OF INDICAN,
ACETONE AND DIACETIC ACID IN VARIOUS PSYCHOSES.— DR.
ISADOR H. CORIAT: Indican, acetone, aceto-acetic and B oxybutyric
acid, when found in large quantities in the urine indicate the existence of
an abnormal retrograde metabolism. From the analyses made it appears
that : increased indican is found to be a manifestation of catatonic and epil-
eptic stupor, akinetic forms of dementia prsecox and general paralysis, in
alcoholic depression and in depressed phases of the mani-depressive psy-
choses. Some unaccountable fluctuations in the amount of indican excreted
were found in some cases. It was difficult to determine what effect diet had
on the elimination of indican in the urine. The elimination of indican
seems to be somewhat greater in condition of stupor than it is in simple
inactive conditions. Excretion of indican is diminished in catatonia with ex-
citement, involution melancholias, exhilaration during the course of general
paralysis, excitement in dementia prsecox and in manic phases of manic-
depressive psychoses. This class of cases may be grouped together as hy-
perkinetic states. Stools, diet and body-weight do not seem to influence
the amount of indican excreted in the conditions mentioned. Acetone and
diacetic acid are closely related, and the remarks about one apply equally
to the other. Acetone was found in all the groups, except in epileptic
272
STUDIES IN INSANITY.
stupor. Diacetic acid was present in melancholia, the akinetic conditions
of dementia prsecox and in general paralysis, also in cases of alcoholic hal-
lucinations with fear. There seems to be no direct parallelism between the
various psychoses and the production of these two bodies. The appearance
of both acetone and diacetic acid, however, may be looked on as the result
of an abnormal metabolism, due to an inanition process. In the manic con-
ditions acetone was detected only once and it is impossible to account for
its presence or to know its significance. On the other hand, in one of the
cases associated with fear, acetone was absent. Excessive acetonuria in
relation to fear was not verified, although Marro claims that such a relation
exists. As it has been shown that inanition stands in close relation to the
production of acetone and diacetic acid, it seems that auto-intoxication as
a factor in producing akinetic conditions may be definitely ruled out.
7. STUDIES IN THE MANIC-DEPRESSIVE INSANITY, WITH
REPORT OF AUTOPSIES IN TWO CASES.— DR. STEWART PAT-
ON : Some think that the periodic psychoses are due to hereditary causes,
while others (Pilcz) considered traumatism or lesions of the brain as im-
portant factors in the causation of these forms of insanity. It is of the
greatest importance to study the anatomical changes of the cerebral and
spinal tissues. From the two reported autopsies of recurrent psychoses
nothing definite can be concluded; in one case, the noted feature was
the presence of "fever changes" in the large elements ; in the second case,
the dura was adherent to the inner table of the skull, over the frontal region ;
several depressions were noted between the convolutions, in which pockets
of fluid were contained between the pia and the arachnoid; there was one
such depression over the parietal lobe ; the arachnoid was opaque to various
degrees in different places; the medullary substance was very soft and the
differentiation was poorly marked. Microscopically, there was a slight in-
crease in the neuroglia elements in the cortex; mitotic figures were seen
here and there ; the nerve cells showed various stages of acute cell-changes ;
there were no vascular changes and the basal ganglia seemed to be normal.
8. DR. ALLISON: There are some bills before the Legislature, with a
view to procuring lawful exclusion of undesirable immigrants (anarchists,
defective, etc.)
9. A CASE OF FEIGNED INSANITY.— The defendant was tried for
murder; he simulated depressive insanity, but was detected, once, when
told to go and sit down near a given window, which he did (he pretended to
be in a condition of dementia) and at another time, he was caught trans-
mitting a note to his lawyer. Another prisoner, when questioned about this
man, admitted that they both discussed in detail the court proceedings which
interested the prisoner here considered.
10. IN THE MANHATTAN STATE HOSPITAL for the Insane, on
Ward's Island, the heating of irons in the laundry is done by electricity.
The Journal of Nervous and Mental Disease, May, 1902:,
1. A CASE OF CHOLESTEATOMA OF THE BRAIN.— DR.
CHARLES LEWIS ALLEN : A man, about 33 years of age, entered the
New Jersey State Hospital, giving a history of having been struck on the
head some time previous to his admission there ; he had since been apparently
insane. He did not speak, appeared to be entirely demented and had, from
time to time, epileptiform convulsions until the time of his death, which took
place in status epilepticus. No symptomatic record could be obtained. On
FRACTURE OF SKULL. 273
the post-mortem examination, no trace of any injury to the skull was found;
the dura was not adherent, but the brain seemed to bulge somewhat in the
left frontal region. On removing the dura, a somewhat grayish white lus-
trous mass was noticed protruding beneath the pia arachnoid, in the second
left frontal convolution; the diameter of this mass was about one centi-
metre. On the inner surface of the hemisphere, the corresponding part of
the mass, like cooked cauliflower in appearance, had pushed the corpus
callosum downward and had indented the convolutions of the opposite hem-
isphere ; this part of the growth was about 4 centimetres in diameter. The
growth occupied the greater part of the frontal lobe, was provided with a
capsule and measured sagitally 8.5 cm., frontally 5.5 cm., and horizontally
3.7 cm. It seemed to have grown from the lateral ventricle towards the
frontal lobe. The ependyma was the apparent origin of the growth.
2. REPORT OF CONDITION OF A MAN THROUGH WHOSE
RIGHT CEREBRUM A BULLET PASSED FROM BEFORE BACK=
WARD, ELEVEN YEARS AGO.— DR. THEODORE DILLER : A boy,
13 years of age, was struck by a bullet that entered the skull, just above the
middle of his right eye brow, and made its exit 0.5 cm. to the left of the oc-
cipital protuberance. The cicatrices of both wounds are plainly visible now.
The accident was followed by unconsciousness that lasted three weeks, at the
end of which the patient was unable to utter a single word and he was
completely hemiplegic on the left side. The power of speech returned after
five weeks, but the paralysis disappeared gradually and incompletely during
the course of the following two years ; after that period, the motor defects
remained stationary. The patient says that an operation was performed on
him immediately after the accident, and that some four or five ounces of
brain substance and parts of bone were removed. The skull depression
measures 13 cm. in its greatest length and 7 cm. in its greatest breadth; it
extends from a point about 0.5 above the middle of the superior orbital
margin to a point 2 cm. behind the parietal eminence. The man is now 24
years of age and exhibits no mental defects; the left leg is spastic, but he
can walk without a cane ; all power of motion in the left hand and forearm
is absent, but limited movements of the left shoulder can be made; there
are marked contractures in the fingers of the left hand, a partial paralysis
of the left face and all forms of sensation are greatly diminished on the left
side, and entirely absent in the arm and hand; there exists left hemian-
opsia. The middle Rolandic and parietal regions were mostly involved,
and it seems that the sensori-motor area must be located in these regions.
The hemianopsia may be due to destruction of the cuneus or to that of the
fibres associating it with the optic centres. The extent of injury that the
brain can tolerate seems to be marked.
3. REPORT OF A CASE OF FRACTURE OF THE BASE OF THE
SKULL FOLLOWED BY MENINGITIS AND ORGANIC HEMI-
PLEGIA, ASSOCIATED WITH COMA AND CATALEPSY
LASTING EIGHTEEN MONTHS.— DR. A. C. BRUSH: An interest-
ing clinical description of a case under the above mentioned heading is
given, but as the patient was still alive, no anatomical data were obtained.
The cataleptic phenomena in connection with organic lesions here are of
great interest.
RICHARD FREIHERR v. KRAFFT=EBING.— A biography of the
psychiatrist and a description of his scientific achievements is given in the
Wiener Klinische Rundschau, March 30, 1902.
274
CEREBRAL TUMOR,
PROCEEDINGS OF THE NEUROLOGICAL SOCIETY OF PARIS,
Nov. ii, 1901. Presided over by Prof. Raymond.
1. CEREBRAL TUMOR WITH AUTOPSY.— MM. KLIPPEL and
JAR VIS : A man, J7 years of age, had hemiplegia of the limbs, but the
facial muscles unaffected; epileptiform attacks, contractures with abolition
of the reflexes, and absence of the ankle clonus ; chorea and trophic dis-
turbances ; there was cedema of the limbs and ulcers of the left heel. Pul-
monary vaso-motor disturbances with hemorrhages. The autopsy revealed
the presence of a tumor of the right paracentral lobule.
2. AKATESIA. — Dr. HASKOVEC designates by this term a condition,
in which it is impossible to remain seated ; he reported two such cases, men,
who, when seated became most restless, agitated by jerks which threw them
out of the chairs ; they were perfectly quiet when in the standing posture or
when walking. They are neurasthenic subjects; this disease is the counter-
form of astasia-abasia.
3. DEFINITION OF HYSTERIA.— DR. BABINSKI: Hysteria is a
psychic affection, characterized by the fact that the subject affected by it is
susceptible to auto-suggestion or to suggestion. The disease is character-
ized principally, by primary disturbances and secondarily, disturbances are
accessory.
4. MENTAL TORTICOLIS ADDED TO SEMICHOREIFORM
MOVEMENTS.— FEINDEL AND MEIGE: A girl, 18 years of age, with
mental debility, has presented, since ten years of age, spasmodic choreiform
movements of the right arm. Recently, mental torticolis was added to the
old motor disturbances; the patient could counter-act the movement by an
antagonistic movement. Treatment during the course of two months rec-
tified the new trouble and amelioriated the choreiform movements of the
arm. The mental condition is little developed.
5. GENERALIZED ANKYLOSIS OF THE SPINAL COLUMN AND
ALL THE JOINTS OF THE BODY.— M. APERTI presented a case in
which all the joints were ankylosed. The disease set in suddenly when the
patient was three years of age ; at that time he had a severe attack of gener-
alized convulsions; after that attack, he was confined to bed during a
period of three years. When he was able to leave his bed it was found that
he had lost the use of his limbs, as every joint in the body was stiff. The
patient is now thirty years of age, and there has been some progressive im-
provement in the condition of the joints. There exist no muscular altera-
tions, no reflex disturbances, no alteration of the electric reactions nor of the
sensibility; the disease, is therefore, not due to any lesion of the central
nervous system. It cannot be said that the case is one of chronic rheuma-
tism, as that disease has an entirely different aspect. It is rather a distinct
osteo-articular affection, which may be designated by the term olomelic
spondylosis, implying that all the limbs are involved.
6. ON A VARIETY OF HYPERTROPHY OF THE LIMBS. MY=
ELOPATHIC INTERSTITIAL DYSTROPHIA.— M. RAPIN presented
a case, a girl, seven years of age; when twenty months of age, she had an
attack of fever, which lasted a few days, and this was followed by hyper-
trophy of the right upper limb ; the upper left limb became similarly af-
fected when the child was three years; old ; there was no febrile manifesta-
tion then. The pathogenesis of these dystrophic manifestations of the con-
nective tissue has much in common with the spinal amyotrophias, particu-
larly in infantile paralysis. Indeed, as a consequence of infantile paralysis
THE TROPHOEDEMAS. 275
is found not only muscular atrophy, but also hypertrophy. Besides the
muscular atrophy, fat-cell proliferation has also been observed. A second
case, that of a woman thirty years of age, presented congenital cellulocu-
taneous hypertrophy.
7. THE TROPH CEDEMAS.— M. H. MEIGE: Under this term is
understood chronic, white, indurated, painless oedema, appearing in scat-
tered areas, and the cause of which is yet unknown. In certain cases,
chronic trophcedema is also hereditary.
Regarding the nature and pathogenesis of this disease, the author con-
siders it as a connective tissue dystrophy, similar to the muscular dystro-
phies, due most probably to impairment of the centres which preside over
the development of the connective tissue. The areal distribution of this
oedema seems to correspond to the hypothesis of metameric alterations of
the nervous centres.
Nosographically, interstitial dystrophy may be classified as congenital,
hereditary, family dystrophy, acute and chronic.
8. CEREBRAL POROSITY.— M. G. GUILLAIN presented specimens
of two cases of cerebral porosity. The appearance, resembling gruyere
cheese, is due to putrefaction, especially during the warm summer months.
9. FAMILY MYOPIA.— M. CESTAN presented two cases of ju-
venile myopathias that belonged to the same family; the disease affected
the four limbs at the onset.
10. GLYCOSURIA AND ALBUMINURIA OF NERVOUS ORIGIN.—
M. J. ROUX presented a case of syphilitic glycosuria and albuminuria, and
was of opinion that the disturbance was of nervous origin.
11. TICS AND MOTOR DISTURBANCES DURING THE COURSE
OF CHRONIC DELIRIUM. THE MUSCULAR SYNDROME AS A
PROGNOSTIC SIGN.— M. DUFOUR presented a case of a woman, 34
years of age, suffering from mental debility; during the last two years she
has been subject to delusions of persecution, hallucinations of hearing
(verbo-psychomotor) of the general sensibility, genital hallucinations and
illusions of sight ; mysticism is the basis of the delirium, giving it a peculiar
clinical aspect. During the last year, the patient has been subject to tics of
the muscles of the neck, upper and lower extremities. These spasms are
intermittent and do not seem to be dependent on any dlusional conception;
they belong to the class of automatic movements, although their complexity
is marked. The appearance of such motor disturbances in a patient suffering
from delusions of two and one half years' standing should be looked on as an
indication of gravity in the prognosis.
Session of December 5, 1901 :
1. CEREBRAL TUMOR IN A CHILD.— MM. LEONOBLE and AU-
BINEAU exhibited the brain of a child, 5 years of age, who was bitten by a
mad dog. The symptoms that followed were : persistent headache, vomiting,
epileptiform attacks, right hemiplegia and nystagmus; there was no dis-
turbance of the general sensibility. The diagnosis of a tumor situated near
the chiasma of the optic nerves was made. At the autopsy this was not
verified. A voluminous tumor was found occupying the entire left lateral
ventricle, the opto-striate nuclei being destroyed ; there was also a large,
isolated tubercle of the pons. This tubercle was a primary one, as there was
no other tubercle lesion in the base of the brain. The infection from the
dog bite and the onset of the disease were simply coincident.
276 HEMORRHAGE OF EXTERNAL CAPSULE.
2. MYOPATHIA WITH NORMAL ELECTRIC CONTRACTILITY.—
M. BRISSAUD presented a case of a child, who was referred to him with a
diagnosis of flaccid chorea, but who was suffering from myopathia of a
marked degree; the particular point of interest consisted in the fact that
the reflexes were entirely abolished and that galvanic and faradic contrac-
tility were entirely intact, presenting an amplitude quite exceptional in
similar cases.
M. Huet had occasion to observe two similar old cases of myopathia, in
so far as the electric reactions were concerned, except the amplitutde;
this depends on the degree of the muscular atrophy. It is natural that Dr.
Brissaud's case should present such a marked amplitutde, because the case is
yet of recent standing. Although the electric contractility is generally de-
creased in myopathia this is not an invariable rule; the contractility may
be simply intact in some, decreased in others, or else present the reaction of
degeneration.
M. Babinsky was of opinion that the patient walked like one affected with
neurirtis and that it was a question as to the correctness of the diagnosis
of myopathia.
3. FOUR CASES OF HEMORRHAGE OF THE EXTERNAL CAP-
SULE WITH HEMIANAESTHESIA.— M. TOUCHE: Out of eleven
cases of hemorrhage of the external capsule, eight presented hemiansesthe-
sia; in the last four cases that came under his observation there were four
cases of hemianaesthesia. Hemiplegia with anaesthesia seems to correspond
to a hemorrhage in the insulo-temporal angle ; the persistency of the hemi-
plegia is proportionate to that of the hemorrhage.
4. ASSOCIATION OF HYSTERICAL HEMIPLEGIA AND INFAN-
TILE CEREBRAL DIPLEGIA.— M. LAIGNEL-LAVASTINE presented
a patient who had an attack of hysterical hemiplegia added to cerebral diple-
gia. The hysterical complication of an organic lesion of the nervous system
was suspected on account of the presence of strong tendon reflexes, spinal
epilepsy with the extension of the toes. The suspicion was verified by the fact
that some improvement was obtained by using suggestion ; M. Babinski said
that hysteria alone never causes exaggeration of the tendon reflexes and
spinal epilepsy.
5. CEREBRAL HEMORRHAGE IN DIABETES.— MM. KLIPPEL
and JARVIS gave the history of a diabetic, who was taken suddenly with
coma that was followed by hemiplegia and ptosis. He was improved on the
following day, and was in his normal condition the day after. The diagnosis
of a transitory hemiplegia due to autointoxication was made. The speech be-
came impaired, however, without there being any new attack of coma, and
the patient died in a condition of incomplete coma. At the autopsy, a large
hemorrhage of the external capsule was found. It is well to be guarded in
giving the prognosis of hemiplegia, apparently of benign nature, during the
course of diabetes.
6. M. HASKOVEC proposed that an international inquest be made into
the matter of marriage among diseased subjects who are apt to transmit their
disease to the offspring. The proposition was considered as being rather
Utopian. A committee will be appointed to consider the value of the prop-
osition.
7. FRONTAL JACKSONIAN EPILEPSY.— M. CHIPAUT: Three
cases of Jacksonian epilepsy observed by the author seem to indicate that
when the lesion lies in the frontal region thtrg sr« iQ fea found m&ter and
AUTO-SUGGESTION OF VERTIGO AND SUICIDE. 277
sensory (stereognostic) alterations of helpful significance, when the foot of
the 1 st and 2d convolutions are involved.
Prof. Raymond reserved his opinion regarding the localization of the
stereognostic and sensory centres.
PROCEEDINGS OF THE SOCIETY OF HYPNOLOGY AND PSY=
CHOLOGY, Paris, Oct. 15, 1901 :
1. AUTO=SUGGESTION OF VERTIGO AND SUICIDE. — M. FE-
LIX REGNAULT reported some cases of suicide due to involuntary auto-
suggestion. One subject, who suffered from obsessional contemplation of
voidness, always experienced a sensation of falling ; therefore, everything he
did was accompanied by an attempted act to fall, the intensity of the act being
in proportion to the vividness of the mental representation.
2. ON THE WILL POWER.— VI. COSTE DE LAGRAVE said that
the act of auto-suggestion is an invaluable aid in the matter of carrying out
propositions in life. Dr. Berillon cited numerous cases, showing that auto-
suggestion and application of the will power can act on almost all the organic
functions ; the vaso-motor phenomena depend especially on this suggestion.
3. A SO=CALLED THOUGHT READER.— DR. PAUL FAREZ:
The mind reader was a native of Salonica, who had performed some suc-
cessful feats of this art ; it was demonstrated that he was nothing more than
a clever interpreter of his subject's subconscious movements, using them
as conductors. These facts are not new; scientifically, they are based on
the same principle as is mental suggestion.
4. A CASE OF PERIODIC MASTURBATION. -M. BLOCH report
ed this case ; the attack of this disease is similar to that of dipsomania. M.
Jules Voisin said that such cases were incurable. M. Berillon said that one
should not make such a grave diagnosis before all available treatment has
been exhausted.
5. A CASE OF VERBAL BLINDNESS. M. BERILLON reported
this case of a young soldier, who could write, but had lost the ability to read.
In another case, that of a child, a similar disturbance was caused by a
suggestion of the child's mother. MM. Bellemaniere, Voison and Magnin
reported similar cases of inhibition.
HEREDITY AND TWIN BIRTHS.— A woman who gave birth to
twins has the following family record: 1, her paternal grandmother twice
gave birth to twin children; 2, a grand aunt had two successive twin
births; 3, a paternal German cousin gave birth to twins and, finally, the
patient's father was one of twin children. On the mother's side, an aunt
gave birth to triplets and died of uterine hemorrhage during this confine-
ment (Progres Medical, March 1, 1902).
THE SOCIETE MEDICO=PSYCHOLOGIQUE of Paris is fifty years
old and celebrated this occasion on the day of its birth, — May 26, 1902. In
the afternoon, the celebration was opened by a speech by the President of
the Society; M. Motet; a report on the Aubanel prize was followed by M.
Arnaud and, finally, Dr. Ritti, the distinguished Secretary of the Society,
presented the history of the works of the Society, In the evening, the gala
occasion ©nckd up with a banquets
278 BOOK REVIEWS.
BOOK REVIEWS,
DIE KOERPERLICHEN ERSCHEINUNGEN DES DE=
LIRIUfl TREMENS. KLINISCHE STUDIEN DR. AU-
GUST DOELLKEN, I. Assistentarzt der Psychiatrischen und
Nervenklinik. Illustrated. Verlag von Veit and Co., Leipzig,
1 901. A classification of the various forms of delirium tremens
is given and one form, not generally known, is added, — delirium
tremens sine delirium. As the title indicates, the delirium alone
is absent, while the other characteristics do not differ from those
found in this form of disease. The chapter on etiology is inter-
esting, giving the foremost views on the subject. Although some
are of opinion that auto-intoxication is the main cause of this
disease, others oppose this view ; alcohol causes definite lesions
and impairment of the cerebral nerve cells, the nutritive supply of
the latter is gradually wasted and the clinical manifestations are
sufficiently explained by these disturbances. Although not all
chronic alcoholists are subject to this delirium, the fact can easily
be explained, nevertheless, by the predilection of the alcohol for
the weakest organ ; the liver, kidneys, brain tissues, etc., may be
affected preferably. The blood pressure, cardiac action and the
mechanism of the circulation in this disease are considered.
EPILEPSIE. TRAITEMENT, ASSISTANCE ET MED=
ECINE MEDICO - LEGALE. — PROF. PAUL KOVALEV-
SKY. Vigot freres, 1901, Paris. An exhaustive chapter of
189 pages is devoted to the history of the development of the
method and care of the epileptics in various countries and in their
individual states. The individual states of the United States are
considered in this regard and the interesting incident of Mrs.
Ruffner's diplomatic coup is related : As she did not succeed,
with the presentation of her petition, to impress on the minds of
the West Virginia Legislature the urgent necessity of providing
suitable quarters for the epileptics, she reappeared before the
legislative body the year following, not with a petition, but with
an epileptic child ; the state of that child was so pitiable that the
stern legislators yielded to her request. One hundred pages are
devoted to the consideration of the clinical study of the disease,
and many valuable points of interest in connection with this dis-
ease can be found here. The numerous references are also help-
ful. Legal medicine plays a prominent part in this study.
BOOK REVIEWS. 279
EPILEPSIA, EIA LETCHENIE I SOUDEBNO - PSY-
CHIATRITCHE5K0E ZNACHENIE. - PROF. PAUL KO-
VALEVSKY. Akinfiev and Leontiev, St. Petersbourg. The
various forms of epilepsy apt to fall under consideration of the
jurist are considered at great length, 352 pages being devoted to
this subject.
TRANSACTIONS OF THE AMERICAN MEDICO-PSY-
CHOLOGICAL ASSOCIATION, 1901. — A number of interest-
ing contributions to the study of mental diseases are given here ;
the majority of these articles have been presented in resume form
in this Journal.
LE MYSTERB POSTHUME. — Causeries medicales sur la
mort et la survie. Li Tai, Docteur en medecine, ancien Major
au Chili. 2d edition. Schleicher Freres, 1901 Paris. A phil-
osophic analysis of life, death, after-life and the relations of hu-
man beings and nations to one another, — all presented in a humor-
isti-pathetic style. The volume is most readable, as well as in-
structive. As many subjects of interest are touched on, phil-
osophy, religion, nationality, statesmanship, etc., the author has
ample range for the display of his varied knowledge in an inim-
itable manner of humor and sarcasm, at opportune moments.
DE LA VALEUR CLINIQUE DU CYTODI AGNOSTIC
CEPHALO - RACHIDIEN DANS LES CAS DOUTEUX DE
PARALYSIE GENERALE PROGRESSIVE.— DR. MAIL-
LARD. These, 1901, Bordeaux. 1 — Syphilis may attack the cere-
brospinal axis at any time during its evolution, without showing
any clinical manifestations to this effect ; the meningeal altera-
tions thus induced are expressed by the presence of lymphocytosis
in the cerebro-spinal fluid ; 2. — the cerebro-spinal fluid of pseudo-
general paralytics, alcoholists and others, may or may not contain
lymphocytes; 3. — the cytodiagnosis is, in itself, not a sufficiently
certain test in cases of doubtful general paralysis ; this test is also
insufficient for the making of a positive diagnosis in the incipient
stage of general paralysis ; 4. — the cerebro-spinal fluid of juvenile
general paralytics is rich in cellular leucocytic elements ; the poly-
nuclear elements are more numerous here than are the lympho-
cytes ;5. — the leucocytosis of the cerebro-spinal fluid, therefore, can
only serve as an index to the existence of an irritation of the
meninges, without indicating the nature of the irritative process ;
6. — the cytodiagnosis of the cerebro-spinal fluid has, therefore, only
a relative clinical value.
2&> BOOK REVIEWS.
LE DELIRE D'AUTO-ACCUSATION (Etude medico-
legale). These, 1900, Bordeaux. Dr. Pierre Oudard. The delir-
ium of the auto-accusation differs from that of culpability; 1, — in
the latter, the patient imagines himself to be culpable, without,
however, accusing himself constantly; whereas, in delirium of
auto-accusation, he accuses himself, without imagining himself to
be culpable. 2, — clinically, the delirium of auto-accusation is
found to exist in the following forms of psycopathic affections:
melancholia, degeneracy, alcoholism and hysteria; 3. — from a
medico-legal standpoint, the author agrees with Professor Regis
in the classification of the forms: cases in which patients accuse
themselves of crimes which are imaginary; self-accusation of real
crimes, but which evidence disproves as having been committed
by the accused; self-accusation of having committed a crime,
which could have been committed by the individual ; marked exag-
geration of some crime committed; 4. — in the majority of these
cases, the insane accuse themselves of having committed crimes
which have never taken place ; in order of frequency of self accusa-
tion the subjects may be grouped thus: degenerate, alcoholists,
melancholiacs, hysterical and infectious delirii ; the order of crimes
mentioned by these subjects is : infanticide, uxoricide, parricide,
fratricide, political and unknown assassinations ; then follow
thefts, plots, adultery, etc. ; the alcoholists accuse themselves most
frequently of having committed homicide, coloring the deed in
more or less dramatic shades ; melancholic women generally ac-
cuse themselves of having committed infanticide and the degen-
erate generally accuse themselves of varied and plausible crimes ;
commitment to an asylum is generally the outcome of such cases
unless liberty is granted.
CONSIDERATIONS PSYCHOLOGIQUES ET HEDICO-
PEDAQOQIQUES SUR UN CAS DE DEGENERESCENCE —
DR. DUSSON. These, 1901, Bordeaux. The great value of this
work consists in the thorough study of one individual, who was
afflicted with mental degeneracy. The study takes up some 167
pages. An analogy between human subjects and lower animals
is shown to exist; psychological study of the youfTg is of great
importance if their education is to be properly directed; par-
ticularly is this the case when the subject suffers from an unbal-
anced psychic equilibrium ; the most accessible psychic avenues in
this subject were those which had any bearing on pleasure or
pain; these traits were utilized in the process of re-education,
which helped transform him into a more normal being than he
was previous to the beginning of the treatment.
BOOKS AND PAMPHLETS RECEIVED.
Dr. Bernard Hollander. MENTAL FUNCTIONS OF THE BRAIN.
AN INVESTIGATION INTO THEIR LOCALIZATION AND THEIR
MANIFESTATION IN HEALTH AND DISEASE. G. B. Putnam's
Sons, New York and London, 190 1.
Dr. Joseph E. Winters. THE FOOD FACTORS AS A CAUSE OF
HEALTH AND DISEASE DURING CHILDHOOD.
Dr. Harry Friedenwald. THE HISTORY OF THE INVENTION
AND OF THE DEVELOPMENT OF THE OPHTHALMOSCOPE.
Dr. Giuseppe Muggia. UN TUMORE DELLA BASE DEL CRANO.
Dr. Antonio D'Ormea. SULLE MODIFICAZIONE DELLA PRES-
SIONE SUB-ARACHNOIDEA E DEI CARATTERI DEL LIQUIDO
CEREBRO-SPINALE NELLA EPILESSIA SPERMENTALE CON 18
FIGURE.
Dr. Frank G. Hyde. NOTES ON THE HEBREW INSANE.
Professor Alfredo Niceforo. LA SOCIOLOGIE CRIMINELLE. LE-
CON FAITE A L'UNIVERblTE DE LAUSANNE.
Dr. William B. Noyes. AN INTRODUCTION TO THE PSYCHO-
LOGICAL STUDY OF BACKWARD CHILDREN.
Dr. Theo. Klingmann. THE POSITION OF THE STUDY OF PSY-
CHOPATHOLOGY IN THE PATHOLOGICAL DEPARTMENT OF
THE MICHIGAN STATE ASYLUMS FOR THE INSANE.
Dr. Theo. Klingmann. A CASE OF MULTIPLE CEREBRO-SPINAL
SCLEROSIS OF A SPECIAL ANATOMICAL FORM, WITH A HIS-
TORY OF PRONOUNCED FAMILY DEFECT.
Dr. Theo. Klingmann. A CONTRIBUTION TO THE PATHOLOGY
OF THE SO-CALLED FUNCTIONAL NEUROSES.
MM. Paul Serieux and M. F. Farnarier. PARALYSIE GENERALE
ET SYPHILIS.
Dr. Bajenoff. OTKRITOJE PISMO DOKTOROU JAKOBIOU PO
POVODOU EVO KNIGUI "OSNOVI ADMINISTRATIVNOI PSY-
CHIATRII."
Professor Alexander Netchaeff. ZUR FRAGE UEBER GEDAECHT-
NISSENTWICKELUNG BEI SCHULKINDER.
Prof. Moritz Benedikt. JURioTICHE BRIEFE.
Dr. Theo Klingmann. BIOLOGICAL STUDIES WITH REFERENCE
TO PATHOLOGY.
PRELIMINARY ANNOUNCEMENT OF THE MICHIGAN COL-
LEGE OF MEDICINE AND SURGERY, 1902-3.
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